2016

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CMS Issues Final Medicare Fee Schedule Rule for 2017

November 2016

Earlier this month, CMS also released the final Medicare physician payment rule which covers payment and regulatory policy for physicians and other Medicare Part B providers.  Overall, CMS projects the final rule will have no impact on pulmonary and sleep providers.  While the overall impact is projected to be zero, there are a few policies that will be of interest to ATS members including:

Removal of Moderate Sedation from Bronchoscopy Codes:  As part of a CMS wide effort to remove conscious sedation from all CPT codes where conscious sedation was previously bundled, CMS has finalized removing the conscious sedation payment from the base code for all services, including pulmonary services.  The removal of conscious sedation from bronchoscopy codes will lead to cuts in the reimbursement level for bronchoscopy codes from 5-10 percent.  Removing conscious sedation from the base code will also impact payment for the infant pulmonary function test CPT 94013 – measuring lung volume through two years of age (-42 percent).

All is not lost.  While the base code has been cut, physicians will now be able to separately bill for providing conscious sedation (CPT codes 999151-99157) with bronchoscopy or infant pulmonary function tests.  The ATS projects most practices will recoup the cuts in bronchoscopy reimbursement through separate billing of moderation sedation services.

The January 2017 issue of the ATS Coding and Billing Quarterly newsletter, the ATS will provide more information on how to adjust coding and billing practices to accommodate the new moderation sedation policy.

Creation of tele-medicine G codes for critical care: In the final rule, CMS created two new G codes to allow remote providers to bill for critical care consultant services provided over the phone. The new codes are:

  • G0508: Telehealth consultation, critical care, physicians typically spend 60 minutes communicating with the patient and providers via telehealth (initial).
  • G0509: Telehealth consultation, critical care, physicians typically spend 50 minutes communicating with the patient and providers via telehealth (subsequent).

Further information on proper use of the new telemedicine ICU codes will be available in the January issue of the ATS Coding and Billing Quarterly.