2012 PFS Final Rule Stands Corrected

The Centers for Medicare & Medicaid Services (CMS) has published corrections to the 2012 Physician Fee Schedule final rule in the Jan. 4 Federal Register.

Several typographical and technical errors needed correction in the preamble and addenda of the final rule that sets Medicare payments to physicians. These corrections are consistent with, and do not make substantive changes to, the policies and payment methodologies that were adopted in the 2012 PFS final rule, so CMS is waiving the standard 30-day comment period and delay in the effective date for these corrections. The document is final and the corrections are effective Jan. 1, 2012.

Due to the number of corrections made to the preamble of the final rule, CMS is replacing the Addenda in their entirety and correcting supporting tables that are available online, such as the time file and the direct PE input database.

Among the corrections, HCPCS Level II code G0450 Screening for sexually transmitted infections, includes laboratory tests for chlamydia, gonorrhea, syphilis and hepatitis b has been removed from Addendum B – Relative Value Units and Related Information Used in Determining Medicare Payments for CY 2012. And the status indicator that appears in Addendum B for CPT® code 96110 Developmental screening, with interpretation and report, per standardized instrument form has been changed.

The physician work and malpractice RVUs for CPT® 90845 Psychoanalysis that appeared in Addenda B and C – Codes with Proposed RVUs Subject to Comment for CY 2012 have also changed.

Also changed is a series of practice expense (PE) relative value units (RVUs) that appeared in Addenda B and C for CPT® codes 90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management, 90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session, and 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re- determination with delivery management.

Further, the price input for the new direct PE equipment item “NeuroStar TMS Therapy System” (EQ342) was incorrectly calculated.

Because work RVUs factor into the calculation for PE RVUs, and time values factor into direct PE input values and specialty-level allocation of indirect PE, PE RVUs for CPT® codes with corrected work RVUs or time values may have also changed as a result of the corrected work RVUs and time values. These changes are reflected in the corrected Addenda B and C and the direct PE database. Note, however, that changes in PE RVUs for other codes not identified may occur due to various factors related to the relativity of the system including budget neutrality, changes in aggregate physician times, and adjustments to maintain PE RVU shares. These changes also are reflected in the corrected versions of Addenda B and C.

Refer to the corrections document for a complete summary of errors and corrections.


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