Pathology/Lab Coding Alert

Question: What conversion factor and program changes should I expect from the 2019 Medicare Physician Fee Schedule?

Codify Subscriber

Answer: First, you should realize that CMS has only issued the proposed Medicare Physician Fee Schedule for 2019, so any information we currently have may change when CMS issues the final MPFS later this fall.

That said, here’s some changes to look out for:

• Lower than last year’s 10-cent bump, the conversion factor proposal is nothing to write home about at a 6-cent increase for inflation and slated to go from $35.99 to $36.05.
• QPP: The MPFS proposals include transition updates, cost and quality scoring changes, threshold guidance, small practice bonus downgrades, and several tech-friendly policies that bring Promoting Interoperability (PI) to center of MIPS.
• Telehealth: Two more codes for telehealth — HCPCS codes G0513 and G0514 (Prolonged preventive service(s)…) — as well as 2018 Bipartisan Budget Act telehealth requirements for end-stage renal disease (ESRD).
• Virtual care: Payment increases for the use of audio and visual communication that “leverage technologies.” This includes a small payment for patients “checking in” with the provider via electronic means when the service isn’t attached to a visit.

Based on all the proposed changes, CMS projects that independent laboratories lead the pack of specialists who will prosper in 2019 if the proposed fee schedule is finalized, with an estimated combined increase of four percent, while rheumatologists, hematologists/oncologists, and diagnostic testing facilities look to see the biggest declines at minus four percent.