CMS Postpones the Implementation of Cardiac Electrophysiology Specialty Designation

The Society will continue to monitor CMS's goals for implementing the new physician specialty code for eventual use:

The Centers for Medicare and Medicaid Services (CMS) announced a delay in the implementation of a new physician specialty code for cardiac electrophysiology. The original date for the new code’s implementation was April 4, 2011, but the date is now July 5, 2011. A recent CMS transmittal, noting that the agency is recognizing two new physician specialty codes — Cardiac Electrophysiology (21) and Sports Medicine (23) — indicated its purpose to attach the correct manual instruction and dates: "the wrong manual update was inadvertently attached previously." It states that the effective date is July 1, 2011 and the implementation date is July 5, 2011.

The Heart Rhythm Society played a critical role in securing the new specialty code designation, which will allow CMS to distinguish an electrophysiologist (EP) from other physicians when billing for Medicare services, and will continue to monitor developments at CMS that affect the cardiac electrophysiology physician specialty designation.

Physicians self-designate their Medicare specialty on either the Medicare Enrollment Application or via the Internet-based, Provider Enrollment, Chain and Ownership System, when they enroll in the Medicare program. Specialty codes are used by CMS for programmatic and claims processing purposes. Currently, there is a risk that claims can be denied as duplicate bills, when two physicians from the same group practice bill for patient evaluation services. The new physician specialty code will differentiate the involvement of two physicians providing distinct services to an individual patient, reducing the chances an EP will be denied an appropriate claim. The Medicare specialty code may lead to a more appropriate level of reimbursement in the future.

Specialty designation is critical to reimbursement because practice-expense relative value units are developed separately by Medicare for each recognized specialty. CMS also is expected to benefit from this new specialty designation, as it will improve the quality of utilization data.

CMS announced the new EP physician specialty designation in December 2010. Because the establishment of the physician specialty code requires changes to the CMS enrollment and claims processing systems, this new designation was targeted for implementation five months following its announcement.