February 2008




2008 Medicare physician fee changes … the saga continues

by Emily Graham ASCRS Government Relations Associate Director



Prior to the end of the year, a flurry of activity on the Hill, namely the Medicare, Medicaid and SCHIP Extension Act of 2007, brought much speculation about proposed changes to the Medicare physician fee schedule for 2008 and beyond. The legislation, which also extended SCHIP funding through March 2009, prevents the 10.1% reduction in Medicare physician reimbursements scheduled to take effect on January 1, 2008 but replaces it with a 0.5% positive update through June 30, 2008. However, because of the financing, physicians will be facing a 10.6% reduction on July 1, 2008, if Congress does not act before that time, noted ASCRS officials.

The year-end legislation also included provisions to extend expiring rural physician payment provisions, and the Physician Quality Reporting Initiative, which will still be voluntary with bonus payments through 2008.

ASCRS noted the probability of a larger Medicare bill next year to be considered under “budget reconciliation” rules. This would mean that there would be only 51 votes necessary for passage in the Senate. Senate Finance Chairman Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA) have indicated that this is a “temporary” patch, and they hope to pass at least a 2-year “fix” next year, ASCRS said.

On January 1, Congress implemented changes to the Medicare Physician Fee schedule as anticipated. In addition to the 0.5% update to the conversion factor ($38.0870) which will be in effect through June 30, 2008, other changes to the Medicare physician fee schedule were implemented.

Changes in the 2008 Final Fee Schedule are as follows:

Budget neutrality

Against a strong recommendation from ophthalmology, other medical specialty societies, and the AMA, CMS will apply a separate budget neutrality (BN) adjustor to the work relative value units (RVUs) due to the increase in work RVUs resulting from the third 5-year review. The agency has revised the BN work adjustor from 0.8816 (or 11.84%) to 0.8806 (or 11.94%) as a result of changes that occurred subsequent to the publication of the 2008 MPFS final rule.

Practice expense

CMS revised the methodology for calculating practice expense (PE) RVUs beginning in 2007 and provided for a 4-year transition for the new PE RVUs under this new methodology. The 2008 MPFS reflects the second year of this transition. Therefore, in 2008, the new methodology will be weighted by 50%.

Eye codes receive increase from 5-year review of work relative value inits As reported previously, CMS will increase the work RVUs for the eye exam codes (CPT 92002, 92004, 92012, 92014) beginning January 1, 2008.

Ophthalmic imaging

Despite a strong argument from ophthalmology, CMS added certain ophthalmologic imaging procedures to the list of procedures that would be subject to the Deficit Reduction Act of 2005 (DRA) provision that caps payment for the technical component of imaging procedures at the payment amount under the hospital outpatient prospective payment system (OPPS). The following codes will be included under the DRA cap beginning January 1, 2008.

• 92135 - Scanning computerized ophthalmic diagnostic imaging (e.g., scanning laser) with I & R • 92235 - Fluorescein angiography (includes multiframe imaging) with I & R • 92240 - Indocyanine-green angiography (include multiframe imaging) with I & R • 92250 - Fundus photography with I & R • 92285 - External ocular photography with I & R for documentation of medical progress (e.g, close-up photography, slit lamp photography, goniophotography, stereo-photography) • 92286 - Special anterior segment photography with I & R; with specular endothelial microscopy and cell count h

For additional informatin, please contact Emily Graham, ASCRS Government Relations, Associate Director.

2008 Medicare physician fee changes … the saga continues 2008 Medicare physician fee changes … the saga continues
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