# CMS Press Release



## RebeccaWoodward* (Oct 30, 2009)

For Immediate Release: Friday, October 30, 2009 
Contact: CMS Office of Public Affairs
202-690-6145 



CMS ANNOUNCES PAYMENT, POLICY CHANGES FOR PHYSICIANS SERVICES TO MEDICARE BENEFICIARIES IN 2010 

The Centers for Medicare & Medicaid Services (CMS) today announced final changes to policies and payment rates for services to be furnished during calendar year (CY 2010) by over 1 million physicians and nonphysician practitioners who are paid under the Medicare Physician Fee Schedule (MPFS).  The MPFS sets payment rates for more than 7,000 types of services in physician offices, hospitals, and other settings.  Today's action complies with federal law, which requires these policies and payment rates to be announced by Nov. 1.

Current law requires CMS to adjust the MPFS payment rates annually based on an update formula which requires application of the Sustainable Growth Rate (SGR) that was adopted in the Balanced Budget Act of 1997.  This formula has yielded negative updates every year beginning in CY 2002, although CMS was able to take administrative steps to avert a reduction in CY 2003, and Congress has taken a series of legislative actions to prevent reductions in CYs 2004-2009.  In the absence of Congressional action for the CY 2010 physician update, the final rule with comment period will reduce the conversion factor for services on or after Jan. 1, 2010 by 21.2 percent rather than the -21.5 percent projected in the proposed rule.  The difference is due to the use of the most recently available data on CMS spending for physicians' services.

“The Administration tried to avert the pending fee schedule cut in the FY 2010 budget proposal that it submitted to Congress, and remains committed to repealing the SGR,” said Jonathan Blum, director of the CMS Center for Medicare Management.   “In the meantime, CMS is finalizing its proposal to remove physician-administered drugs from the definition of ‘physicians' services' for purposes of computing the physician fee schedule update.  While this decision will not affect payments for services during CY 2010, CMS projects it will have a positive effect on future payment updates.”



In the final rule with comment period, CMS is also adopting several refinements to Medicare payments to physicians which will improve payment rates for primary care services relative to other services.  For 2010, for purposes of establishing the practice expense (PE) relative value units (RVUs), CMS had proposed to include data about physicians' practice costs from a new survey, the Physician Practice Information Survey (PPIS), designed and conducted by the American Medical Association.  CMS is finalizing the proposal, but will phase it in over a four year period.  In addition, CMS will not use the PPIS data to determine the practice expenses for  medical oncology, but instead will continue to use specialty supplemental survey data , as indicated by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA).

CMS is also finalizing its proposal to stop making payment for consultation codes other than the G codes that are used to bill for telehealth consultations, and to redistribute the resulting savings to increase payments for the existing evaluation and management (E/M) services.   CMS will adjust the payment for the surgical global period to reflect the higher value of the office visits furnished during the global period.

In the final rule with comment period, CMS is adopting two significant modifications to its proposal to increase the equipment utilization percentage that is assumed for purposes of setting PE RVUs.  CMS will increase the equipment utilization rate assumption used to determine the practice expense for expensive equipment priced over one million dollars from 50 to 90 percent but will phase in this change over a four year period.  CMS also will not apply this change to expensive therapeutic equipment.

CMS is increasing payment for the Initial Preventive Physical Exam (IPPE), also called the “Welcome to Medicare” visit to be more in line with payment rates for higher complexity services.   Originally established in the MMA, the IPPE benefit now pays for an initial assessment of key elements of a beneficiary's health within one year of the beneficiary's enrollment in Medicare Part B.

Taking all changes in the final rule with comment period into account, CMS projects that payments to general practitioners, family physicians, internists, and geriatric specialists will increase by between 5 and 8 percent, prior to application of the negative update required by the SGR.

The final rule with comment period also implements a number of provisions in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) including:

Adding new Medicare benefit categories for cardiac and pulmonary rehabilitation services and for chronic kidney disease (CKD) education beginning Jan. 1, 2010.   The final rule with comment period outlines what these programs will entail, how they will be paid under the MPFS and the criteria for covering these services.  
Increasing the Medicare share of payments for outpatient mental health services to 55 percent from 50 percent, beginning a gradual transition to bring payment parity for mental health and medical services furnished to Medicare beneficiaries.  
Implementing a requirement that suppliers of the technical component of advanced imaging services be accredited beginning Jan. 1, 2012.   The accreditation requirement will apply to mobile units, physicians' offices, and independent diagnostic testing facilities that create the images, but will not apply to the physician who interprets them.  CMS will address suppliers' accountability, business integrity, physician and technician training, service quality, and performance management through additional guidance.  
The final rule with comment period contains a number of provisions to promote improvement in quality of care and patient outcomes through revisions to the Electronic Prescribing Incentive Program (e-Prescribing Program) and the Physician Quality Reporting Initiative (PQRI).  Specifically, the final rule simplifies the reporting requirements for the electronic prescribing measure, provides eligible professionals with more reporting options, and establishes a new process for group practices to be considered successful electronic prescribers.  Eligible professionals or group practices that meet the requirements of each program in CY 2010 will be eligible for incentive payments for each program equal to 2.0 percent of their total estimated allowed charges for the reporting periods. 

In addition, CMS is adding measures for eligible professionals to report under the PQRI, providing a mechanism for participants to submit quality measure data from a qualified electronic health record and creating a process for group practices to use for reporting the quality measures.

The final rule with comment will appear in the Nov. 25, 2009 Federal Register.  CMS will accept comments on designated provisions of the final rule with comment period until Dec. 29, 2009, and will respond to all comments at a later date.  Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after Jan. 1, 2010.

To view a copy of the final rule with comment period, please see:

www.federalregister.gov/inspection.aspx#special

A fact sheet providing more information about the e-Prescribing Program and PQRI provisions can be found at:

www.cms.hhs.gov/apps/media/fact_sheets.asp

http://www.cms.hhs.gov/apps/media/p...ge=&showAll=&pYear=&year=&desc=&cboOrder=date


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## Lisa Bledsoe (Oct 30, 2009)

Thanks Rebecca - I was going to post this as well


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## RebeccaWoodward* (Nov 1, 2009)

CMS is also *finalizing * its proposal to stop making payment for consultation codes other than the G codes that are used to bill for telehealth consultations, and to redistribute the resulting savings to increase payments for the existing evaluation and management (E/M) services. CMS will adjust the payment for the surgical global period to reflect the higher value of the office visits furnished during the global period.


The final rule with comment will appear in the Nov. 25, 2009 Federal Register. CMS will accept comments on designated provisions of the final rule with comment period until Dec. 29, 2009, and will respond to all comments at a later date. *Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after Jan. 1, 2010.*

Looks like the final phase is wrapping up...Should make for an interesting new year....


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## Lisa Bledsoe (Nov 2, 2009)

The next 6 weeks or so should prove very interesting as well, with the final rule for the conversion factor...aren't we all looking forward to a 21.2% cut?


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## Gemini18 (Nov 16, 2009)

*Consultation Codes*

I am trying to understand the new process for Jan. 1, 2010 with the elimination of the consultation codes.

What are we going to use in place of them?  I hear we use subsequent visits then I hear we use initial.  What exactly are we using?  I could not open the CMS website this weekend.

Thanks.

Karen


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## RebeccaWoodward* (Nov 16, 2009)

The "buzz" that I'm hearing is that consults will be replaced with Admission codes.  For those consults that don't meet 99221 (detail, detailed, SF/low MDM), it's thought that the subsequent hospital codes (99231, 99232) will replace 99251/99252. Others think that 99499 will still be the alternative.  One medical director for a MAC carrier suggested that 99231/99232 may become carrier discretion.  

The office consultations will be replaced with 99201-99215.  

There is also some chatter that the replaced consultation visits will allow shared visits, whereas, consultations could not be shared visits in the past.

Should be interesting and very confusing....


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## Gemini18 (Nov 16, 2009)

rebeccawoodward said:


> The "buzz" that I'm hearing is that consults will be replaced with Admission codes.  For those consults that don't meet 99221 (detail, detailed, SF/low MDM), it's thought that the subsequent hospital codes (99231, 99232) will replace 99251/99252. Others think that 99499 will still be the alternative.  One medical director for a MAC carrier suggested that 99231/99232 may become carrier discretion.
> 
> The office consultations will be replaced with 99201-99215.
> 
> ...



Thanks!

The chatter is more confusing - LOL. I'm hearing so many different things.

It's going to me one heck of a first year with this -- can't wait.


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## MissTaylor (Nov 20, 2009)

Thanks so much!!!!


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## LindaEV (Nov 20, 2009)

In the OFFICE...instead of consult codes, dr's will be using the new/estab E/M codes 99201-99215. 

In the HOSPITAL...all docs are to use "initial" hosp visit codes the first time they see the patient ( We tend to call these the "admit" codes, but they are labled as initial) 99221-99223. The actual ADMITTING dr will use the same code, but Medicare will soon be releasing a special modifier to add to signify he is the ADMITTING dr. They say they will allow more than one "initial" visit per day.
subsequent visits will be the normal hosp subsequent codes.

The trick being what to do if the patient has a commercial plan primary or secondary, who may still accept consult codes.

This is going to be interesting!


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## maryetuf (Nov 22, 2009)

*Will commercial payors eliminate consult codes as well?*

Does anyone know for a fact if commercial payors will follow suit and eliminate consult codes as CMS has done?  I have been trying to no avail to find definite information for Anthem, Cigna, Aetna, United Healthcare, etc, as to whether or not they will still reimburse consults.  If anyone has any info, I would appreciate it.  Thank you.


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