Wiki 2019 updated Biopsy Codes Fee schedules

[salorn88@aol.com]

Looking for some assistance on how or where to obtain fee schedule for the updated biopsy codes that are being implemented for 2019.
CPT codes 11100 and add on 11101 are now being replaced with the following:
11102 - +11103
11104 - +11105
11106 - +11107

But have no idea what the cost or fees are. Your assistance is greatly appreciated.

 

[robertn.meza]

Hi there! Which state and county are you located in? Once you provide this information i’d be more than happy to help you determine the allowable rates for Medicare.
You may need to contact the commercial insurance companies your company holds contracts with to determine the contracted rates!

Robert Meza
http://linkedin.com/in/dermbillingexpert

 

[CodingKing]

The Medicare Physician fee schedule lookup tool has since been updated with the 2019 rates: https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx

I'm not sure if the MAC publishes their fee schedule first or not. There are also files with pre-calculated rates for all localities - https://www.cms.gov/Medicare/Medica...icianFeeSched/PFS-Carrier-Specific-Files.html

Worst case you can download the PFS RVU files and calculate on you own. They are initially published in November.

https://www.cms.gov/medicare/medica...ysicianfeesched/pfs-relative-value-files.html

You can use the PPRRVU file to get the RVUs and GPCI files for the geographic adjustments

The formula is :

2019 Non-Facility Pricing Amount =
[(Work RVU * Work GPCI) +
(Non-Facility PE RVU * PE GPCI) +
(MP RVU * MP GPCI)] * Conversion Factor (CF)

2019 Facility Pricing Amount =
[(Work RVU * Work GPCI) +
(Facility PE RVU * PE GPCI) +
(MP RVU * MP GPCI)] * Conversion Factor