CMS Issues 2012 Final Physician Fee Schedule

CMS Issues 2012 Final Physician Fee Schedule. On July 19, 2011, the Centers for Medicare and Medicaid Services (“CMS”) published in the Federal Register its CY 2012 Physician Fee Schedule Proposed Rule (“Proposed Rule”). On November 1, 2011, CMS issued its 2012 Final Physician Fee Schedule (“Final Rule”), in part, to “address changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services.” Some key provisions of the Final Rule are set forth below:

  • Payment Reduction Pursuant to the Sustainable Growth Rate – Payments to providers under the Medicare Physician Fee Schedule is set to be reduced by 27.4%, as required by the Sustainable Growth Rate formula, beginning January 1, 2012 absent legislative measures to block to reduction.
  • Addition of Certain Telehealth Services – Generally speaking, CMS reimburses providers for telehealth services–located at a distant site–furnished to an eligible telehealth beneficiary in an originating site. In the Final Rule, CMS proposes adding smoking cessation services to the services to the list of Medicare telehealth services, but notably, chose not to include online evaluation and management (“E&M”) services (i.e., to add CPT code 99444) because “(1) these services are non-face-to-face; and (2) the code descriptor includes language that recognizes the provision of services to parties other than the beneficiary and for whom Medicare does not provide coverage (for example, a guardian).”
  • Expansion of the Multiple Procedure Payment Reduction (“MPPR”) – The MPPR has been expanded to include the professional component of certain advanced diagnostic imaging services. For a more detailed explanation of this change, please see this blog entry.
  • Anesthesia Fee Schedule Conversion Factor – For 2012, the anesthesia conversion factor is $24.6712 with the national average anesthesia conversion factor equal to $15.5264, a decrease of 26.2% from 2011.
  • Additions to the Physician Self-Referral List of CPT/HCPCS Codes – Beginning January 1, 2012, the following tables provide the codes will be added and removed as designated health services (“DHS”) for purposes of the physician self-referral law (a/k/a the Stark Law):

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For more information, please contact The Health Law Partners at (248) 996-8510, (212) 734-0128 or (770) 804-4700 or visit the HLP website.

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