Medicare Physician Fee Schedule

November 30, 2019
Published by Nikki Golden at November 30, 2019
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CMS Issues Final Rule for 2020 Medicare Physician Fee Schedule

In addition to the proposed RVU changes for CPT 27279, the 2020 Medicare Physician Fee Rule updated several policies of relevance to ISASS members. Payment is made under the Physician Fee Schedule (PFS) for services furnished by physicians and other practitioners in all sites of service. These services include, but are not limited to, office visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services. In addition to physicians, payment is made under the PFS to a variety of practitioners and entities, including nurse practitioners, physician assistants, and physical therapists, as well as radiation therapy centers and independent diagnostic testing facilities. Payments are based on the relative resources typically used to furnish the service. Relative value units (RVUs) are […]
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November 30, 2019
Published by Nikki Golden at November 30, 2019
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CMS Medicare Physician Fee Schedule Final Rule Increases Value for Minimally Invasive SI Joint Spine Fusion

In the 2020 Medicare Physician Fee Schedule Final Rule, released on Nov. 1, CMS finalized a work RVU of 12.13 for CPT code 27279, Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device. The current (2019) work RVU for 27279 is 9.03 so the increase is 3.10 or approximately 33%.  In addition, the Total RVUS for CPT 27279 changed from 2019 to 2020 from 19.99 to 25.34. These increases have long been advocated by ISASS and other stakeholders. ISASS had submitted comments to CMS on the 2020 Medicare Physician Fee Schedule Proposed Rule in September, where CMS indicated a proposed value of 9.03 work RVU. At […]
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September 30, 2019
Published by Nikki Golden at September 30, 2019
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ISASS Comments on Medicare Physician Fee Schedule CY 2020 Proposed Rule, Address Misvaluation of 27279

On September 23, ISASS submitted comments to the Centers for Medicare and Medicaid Services (CMS) on their proposed rule for CY 2020 for the Medicare Physician Fee Schedule (released on July 29). The ISASS letter addressed several issues of relevance to ISASS member reimbursement regulation, including the Medicare payment for CPT code 27279, Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device. In the proposed rule, CMS indicated a proposed value of 9.03 work RVU, but that they were seeking comment on whether to adopt a work RVU of 20.00 which is the work RVU for CPT code 27280, Arthrodesis, open, sacroiliac joint, including obtaining bone […]
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July 30, 2019
Published by Nikki Golden at July 30, 2019
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Centers for Medicare and Medicaid Services (CMS) Issues a Proposed Rule for 2020 Medicare Physician Fee Schedule

On July 29, CMS published the proposed Physician Fee Schedule Rule for 2020. In the proposed rule, the Centers for Medicare and Medicaid Services (CMS) has proposed several changes that will affect ISASS members: With the budget neutrality adjustment to account for relative value changes, as required by law, the proposed 2020 PFS conversion factor is $36.09, a slight increase above the 2018 PFS conversion factor of $36.05. CMS proposed payments for new structural allograft codes used in orthopaedic trauma and oncology services (new CPT codes, 209X3, Osteoarticular Allograft, 209X4, Hemicortical Intercannulary Allograft, and 209X5, Interarticular Intercannulary Allograft Complex) CMS proposed updated payments for plain film X-ray codes for spine (CPT codes 72020-72220) CMS proposed updated payments for Patient Office […]
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