MPFSDB October Update Brings More Changes

In the last EdgeBlast issue, we reported that HCPCS Level II codes for the H1N1 vaccine and Bevacizumab injection were recently added to the Medicare Physician Fee Schedule Database (MPFSDB), but you should also note other important changes this year’s October update holds in store.

The following changes are effective for dates of service on or after Jan. 1:

CPT® Descriptor Action
38999   Unlisted procedure, hemic or lymphatic system Assistant at Surgery Indicator: 0
55899   Unlisted procedure, male genital system Assistant at Surgery Indicator: 0
69200   Removal foreign body from external auditory canal; without general anesthesia Bilateral Indicator: 1
93503   Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes Transitional Facility PE RVU: 0.75
Fully Implemented Facility PE RVU: 0.77

The Centers for Medicare & Medicaid Services (CMS) noted earlier that CPT® code 93351 (26) Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with physician supervision (Professional component) as typically not paid under the MPFS when provided in a facility setting, and the PE RVUs noted were informational only. Since then, CMS has clarified that CPT® code 93351 (26) is payable when performed by a physician in a facility setting. The payment file has been updated to reflect this change.

You should also note that the type of service (TOS) for Category III code 0200T Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device (if utilized), one or more needles was mistakenly listed as “9.” The correct TOS is “2.” This change is effective for dates of service on and after July 1.

Claims adjustments will not be made automatically. If these changes affect claims your practice has already submitted, contact your Medicare payer.

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