CMS Updates Physician Fee Schedule

Several new codes with retroactive effective dates highlight the April update to the 2012 Medicare Physician Fee Schedule Database (MPFSDB). The quarterly adjustment, mandated by the Centers for Medicare & Medicaid Services (CMS), means that you may want to re-examine claims using some of the retroactively effective codes and contact your Medicare administrative contractor (MAC) for any possible payment adjustments.

CMS is correcting payments for all anesthesia codes for 2011 and for the first part of  2012. New anesthesia conversion factor files will be made available for 2011 and 2012 as part of the changes requested in transmittal 2429. Practitioners may elect to have payments adjusted on claims for anesthesia services where the provided service dates fall between Jan. 1, 2012 and March 1, 2012. The new 2012 anesthesia conversion factor file will be used by payers to adjust these payments, and it is the same file to be used to calculate anesthesia claims for the rest of  2012 (file effective date from Jan. 1, 2012 to Dec. 31, 2012). Contractors have been previously directed to start processing anesthesia claims with the revised 2012 anesthesia conversion factor file, with dates of service March 1, 2012 and forward. You may elect to have payments adjusted on claims for anesthesia services, where the provided service dates fall between Jan. 1, 2011 and Dec. 31, 2011. Contact your local carrier and bring to their attention these anesthesia payment adjustments, noting that the corrected conversion factors are different for 2011 and 2012.

The following codes have revised MPFS payment indicators effective Jan. 1, 2012:

43775 Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy)
Global surgery is changed to 90 days.

92072 Fitting of contact lens for management of keratoconus, initial fitting
Bilateral surgery indicator is now 2.

4050F Hypertension plan of care documented as appropriate (NMA – No Measure Associated)
The Procedure Status is now M.

New codes being added with an effective date of April 1, 2012 are:

S0353 Treatment planning and care coordination management for cancer; initial treatment

S0354 Treatment planning and care coordination management for cancer; established patient with a change of regiment

S3721 Phakic intraocular lens for correction of refractive error

S8930 Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-on-one contact with the patient

HCPCS Level II codes effective Jan. 1, 2012 are:

G8675 Most recent systolic blood pressure >= 140 mm hg

G8676 Most recent diastolic blood pressure >= 90 mm hg

G8677 Most recent systolic blood pressure < 130 mm hg

G8678 Most recent systolic blood pressure 130 to 139 mm hg

G8679 Most recent diastolic blood pressure < 80 mm hg

G8680 Most recent diastolic blood pressure 80-89 mm hg

The following codes (for which there are only short descriptors) are added effective July 1, 2011:

G9148 National Committee for Quality Assurance – Level I medical home

G9149 National Committee for Quality Assurance – Level II medical home

G9150 National Committee for Quality Assurance – Level III medical home

G9151 Multi-payer advanced primary care practice (MAPCP) demonstration, state

G9152 Multi-payer advanced primary care practice (MAPCP) demonstration, community

G9153 Multi-payer advanced primary care practice (MAPCP) demonstration, physician

The following codes are discontinued from the MPFS effective April 1, 2012:

S3711, S3713, S3718, S3719, S3820, S3822, S3823, S3828, S3829, S3830, S3831, S3835, S3837, S3843, S3848, S3851, S3860, S3862, S8049

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One Response to “CMS Updates Physician Fee Schedule”

  1. Malika Smith says:

    For HCPCS G9148-G9153, is the effective day suppose to be 7/1/2012 or are these late additions that will become effective retro-actively effective 7/1/2011? Any additional information would be great.

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