The Centers for Medicare and Medicaid Services (CMS) has released a technical correction to the 2010 Medicare Physician Fee Schedule, which results in payment increases for myocardial perfusion imaging (MPI) codes, cardiac CT codes, and cardiac catheterization codes, retroactive to Jan. 1, 2010. The correction notice also includes a minor increase in the Medicare conversion factor (from 36.066 to 36. 0791) effective June through December 2010.
The corrections to MPI and CT codes address errors made in incorporating RUC recommendations on direct practice expenses (e.g., medical supplies, equipment time) for these services. The errors included incorrect practice expense values for CPT codes 75571 – 75574 and 78451-78454. For example, the corrected national average payment for 78452 (SPECT MPI, multiple) is $439, compared to the $379 published in the November Final Rule. The American Society of Nuclear Cardiology, the Society of Nuclear Medicine and the American Medical Association identified the errors in the SPECT codes. Society of Cardiovascular Computed Tomography (SCCT) and ACC worked with CMS to correct errors in the cardiac CT codes.
The correction notice also includes changes to malpractice RVUs for cardiac catheterization services. In the Final Rule for the 2010 Medicare Physician Fee Schedule, CMS agreed with ACC, SCAI, and the AMA that cardiac cath services should be assigned malpractice RVUs based on the higher surgical risk factor. However, the published RVUs and payment rates did not correctly reflect that policy change. With this notice, CMS has corrected its error. The payment changes -- for example, an increase from $235 to $253 for 93510 -26 (Left heart catheterization, professional component) -- reflect the higher risk associated with invasive procedures. Click here for an ACC-prepared chart on specific corrections.
The ACC has received word from the Office of Inspector General (OIG) that physicians will not have to charge their patients additional copay amounts as a result of these technical correction. While this is good news, we are still waiting for guidance on when the adjusted payments from Medicare contractors will start. For more information on the new OIG policy, click here.