Medicare Compliance & Reimbursement
Dozens of Physician Procedures Slashed in 2004 Fee Schedule
99311, 45385, 99348 among hardest hit. The Centers for Medicare & Medicaid Services released a list of the high-volume services facing big changes as part of its draft regulation for the 2004 Physician Fee Schedule . The draft was published in the Aug. 15 Federal Register, and providers have until Oct. 7 to comment. The biggest news in the rule is that CMS still expects to slash physician payments by 4.2 percent across the board next year. But some services face a much bigger cut than just 4.2 percent. Many nursing facility care codes are slated for double-digit decreases in their non-facility RVUs. The hardest hit will be 99311 (Subsequent nursing facility care), which will drop from an estimated $40.83 to $32.07. Other codes include 99301 (was $71, now $58.85), 99302 (was $96.75, now $79.29), 99303 (was $119.92, now $98.32), 99312 (was $62.54, now $52.86) and 99313 (was $85.71, now $72.95). Some of these same codes will see smaller drops or even modest increases in their facility-based RVUs. For example, 99311 will increase from $30.53 to $32.07, and 99312 will rise from $50.40 to $52.86. Meanwhile, two home visit codes, 99348 and 99350, will drop about 10 percent to $66.60 and $152.94 respectively. Even as CMS simplified coding for skin lesions, it whacked several big-ticket lesion removal codes. It slashed the estimated nonfacility payment for 45385 (lesion removal, colonoscopy) from $545.53 to $475.40, and 67210 (treatment of retinal lesion) drops from $604.39 to $547.64. Also, 43239 (upper endoscopy, biopsy) dropped from $337.69 to $308, and 17000* (destroy benign/premlg lesion) will fall from $61.43 to $57.44. A few codes will see increases in their nonfacility RVUs. The first hour of critical care (99291) will rise from $210.05 to $230.12, and 93510-26 (left heart catheterization) will rise from $231.38 to $238.58. Also, GXX17 (ESRD services, age 20+, 4+ visits per month) will rise from $262.28 to $293.20 for both facility and nonfacility payments. The draft 2004 Physician Fee Schedule regulation is at http://cms.hhs.gov/physicians/.
Physicians who see lots of patients in the nursing home or home care settings could be seeing particularly steep decreases in payments for 2004.
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