Attention All Anesthesiologists – The 2010 CMS Proposed Physician Fee Schedule Has Been Posted!

If you’re a physician, the Centers for Medicare and Medicaid Services (CMS) Proposed Physician Fee Schedule for 2010 affects you. As a matter of fact, according to the proposed rule, Medicare will cut spending on physician services by 21.5% beginning in January 2010. The finalized fee schedule will be released in November. For anesthesiologists, in particular, the national average anesthesia conversion factor of $20.92 will decrease to $16.42! But a cut in the average conversion factor is not the only change in store for anesthesiologists if this proposition is finalized.

For teaching anesthesiologists, there are changes. For example, teaching anesthesiologists who are involved in two concurrent resident cases will receive 100% payment for both cases. The proposed rule also addresses mixed concurrent case scenarios. CMS has determined that in a mixed concurrent case scenario (e.g., one resident case and one CRNA case going on concurrently), CMS will pay the unreduced fee schedule rate for the teaching resident case and the medically directed rate for the CRNA case. In the medically directed CRNA room, the CRNA and the anesthesiologist will each be permitted to bill fifty percent (50%) if the medical direction requirements are met. CMS also takes a narrow controversial view of hand-offs in the teaching scenario. An issue also arises as to the effect on a teaching case if the anesthesiologist is involved in more than one additional medically directed case. In the proposed rule, CMS clarifies that in order for the anesthesiologist to receive 100% payment for the teaching resident case, the teaching case must be the only case or must be concurrent to only one other case that is being medically directed by the anesthesiologist. The rules for teaching CRNAs have also changed to benefit CRNAs. A CRNA teaching students in two concurrent cases will receive the unreduced fee schedule amount for each case as long as the CRNA is not being medically directed by an anesthesiologist. CRNAs and anesthesiologists should be informed on these particular provisions for the upcoming calendar year. To see more details on these changes, please visit the 2010 CMS Proposed Physician Fee Schedule and our synopsis of the changes on our anesthesia specialty page.

For more information, please call Abby Pendleton, Esq. at (248) 996-8510 or visit The HLP website.

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