Update on Medicare Fee Schedule

The Medicare Fee Schedule is changing again. This change has nothing to do with the 21% decrease we have been discussing which is still up in the air and needs to be decided by June 1, 2010 or we will be in a Medicare holding pattern for 10 business days again. This new change is because of the heatlhcare reform regulations that recently passed in March 2010. It seems that some of the regulations passed in March 2010 has implications of changing Medicare reimbursements. I am including with my Blog a Medicare fee schedule spreadsheet to provide you with the changes by top CPT Codes you all use. The fees in this spreadsheet are for the Central Coast of California area, other areas of the country will have different fees. These changes are retro back to January 1, 2010, and this was all put into place on May 19, 2010. The following is what CMS (Medicare) posted on their Web Site:

Jurisdiction 1 Part B

Medicare Physician Fee Schedule: Implementation of the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act. One week later, on March 30, the President also signed into law the Health Care and Education Reconciliation Act of 2010. These two new laws have a significant impact on the Medicare program and many of the provisions have effective dates prior to this point in time. Over the past several weeks, the Centers for Medicare & Medicaid Services (CMS) has begun implementing various provisions of the new laws, including those with past effective dates. In addition to implementing these legislative changes, the Medicare Physician Fee Schedule is being updated to include certain corrections, retroactive to January 1, 2010, as prescribed in recently published notices in the Federal Register.

Once Medicare contractors have the new payment files in place, per the above, all claims going forward will be processed at the revised rates.

However, we continue to work on the best way to address the many claims that are paid at the rates that were in place before the current corrections and updates are made. Please be on the alert for further information about how CMS will address past claims. Until then, providers should NOT resubmit previously-processed claims affected by the payment changes, as it is likely that these resubmissions may be denied as duplicate claims.

2010 Revised Medicare Rates – 5/19/2010		SLO County

CPT Codes	Description	January 1, 2010	May 19, 2010	Difference	% difference
99201	New pt office visit	39.80	39.79	(0.01)	-0.03%
99202	New pt office visit, expanded	68.58	68.37	(0.21)	-0.31%
99203	New pt office visit, detailed	99.01	99.00	(0.01)	-0.01%
99204	New pt office visit, comprehensive	152.93	153.11	0.18	0.12%
99205	New pt office visit, complex	192.07	192.04	(0.03)	-0.02%
99211	Est. pt office visit	19.72	19.72	0.00	0.00%
99212	Est. pt office visit, prob focused	39.80	39.79	(0.01)	-0.03%
99213	Est. pt office visit, detailed	66.78	66.39	(0.39)	-0.58%
99214	Est. pt office visit, comprehensive	99.99	99.40	(0.59)	-0.59%
99215	Est. pt office visit, complex	134.59	133.99	(0.60)	-0.45%
99221	Initial hosp, low complexity	94.87	94.85	(0.02)	-0.02%
99222	Initial hosp, moderate complexity	129.12	128.91	(0.21)	-0.16%
99223	Subsequent hosp, high complexity	190.04	190.21	0.17	0.09%
99231	Subsequent hosp, low complexity	38.33	37.95	(0.38)	-0.99%
99232	Subsequent hosp, moderate complexity	69.08	68.87	(0.21)	-0.30%
99233	Subsequent hosp, high complexity	99.09	98.88	(0.21)	-0.21%