Updated December 11, 2009

Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B (for CY 2010)

The Centers for Medicare & Medicaid Services (CMS) released the final rule that will revise the Medicare Physician Fee Schedule (MFPS) for calendar year (CY) 2010. This was released, with a comment period, for public display at the Office of the Federal Register's Public Inspection Desk on October 30, 2009. The final rule will be published in the Federal Register on November 25. The agency will accept public comments on the final rule until December 29. Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after January 1, 2010. [Read the November 4 letter e-mailed to members from Heart Rhythm Society President Richard L. Page, MD, FHRS]

During the interim, the final rule is available for review and download. To view a copy of the final rule, please visit The Federal Register website.

Highlights of the Final Rule

• In the absence of Congressional action, the final rule will reduce the Conversion Factor by 21.2 percent rather that the 21.5 percent projected in the proposed rule. This means an across the board cut in reimbursement rates for physician services unless Congress takes legislative action to avert the cut. The preliminary estimate for the Sustainable Growth Rate (SGR) for CY 2010 is -8.8 percent and the Conversion Factor is $28.4061, down from $36.0666 for 2009.
  
• • on December 10, CMS  published a document correcting many technical and typographical errors in the November 25, 2009 physician fee schedule final rule for CY 2010. Among many other things, CMS  changed the convertion factor from $28.4061 to $28.3895.
    
• CMS will finalize its proposal to remove the costs of physician-administered drugs from the SGR formula. While this decision will not change the 21.2 percent payment rate cut for services furnished on or after January 1, 2010, CMS projects it will have a positive effect on future payment updates.
  
• CMS will finalize its proposal to use the American Medical Association Physician Practice Information Survey (PPIS) data to update the Practice Expense/Per Hour (PE/HR) rate to calculate PE relative value units (RVU). The data will be phased in over a four-year period. The four-year phase-in will blend the current data from the supplemental survey with the PPIS data as follows: 75/25, 50/50, 25/75, 0/100. The impact of the PE/HR for cardiology services, as estimated by CMS is as follows:

• CMS estimates payments to cardiologists as a whole for CY 2010 based on the combined impact of Work, PE and Malpractice RVU changes will reflect an 8 percent decrease during the four-year transition period. At the conclusion of the four-year transition period the total decrease is estimated to be 13 percent. These estimates do not take into account the scheduled 21.2 percent negative update.

• CMS accepted the Heart Rhythm Society's comments on Malpractice RVUs and will not assign non-surgical RVUs for codes 93600 through 93613; 93650 through 93652; and 93617 through 93641. Also, codes with no physician work will receive a 0.01 Malpractice RVU instead of zero RVUs as proposed.
  
• CMS will finalize its proposal to discontinue payment for Consultation services performed in the office and hospital setting. These services will now be reported with existing E&M service codes. CMS will create a modifier to identify the admitting physician from other specialty physicians in the hospital setting. CMS will also create new HPCPS G-codes for reporting Consultation services delivered via telehealth.
• CMS will conclude the 4-year transition period for use of the top-down/bottom-up methodology to calculate PE RVUs. In CY 2010, PE RVUs will be calculated based entirely on the bottom-up methodology.
  
• CMS will modify and finalize its proposal to change the equipment usage assumption from the current 50 percent usage rate to a 90 percent usage rate for equipment priced over $1 million (specifically MRIs and CTs), but will phase in the change over a four-year period. CMS will not apply this change to expensive therapeutic equipment.
  
• The 1.000 work GPCI floor, as required by section 134(a) of the MIPPA, will expire effective January 1, 2010. CMS did not propose any changes in the MPFS locality structure, as they do not have authority to extend this provision beyond December 31, 2009.
  
• CMS is continuing to examine alternatives ways to identify Potentially Misvalued Services under the MPFS, specifically high cost supplies, services often billed together, and possible expansion of the Multiple Procedure Payment Reduction to non-surgical procedures and will continue to work with the AMA RUC on these issues.
  
• CMS will not finalize its proposal to not allow a separate E/M service to be billed for care furnished during the post procedure period for an outpatient service hospital stay.
• CMS will finalize its proposal to require suppliers of the technical component of advanced imaging services (computed tomography, magnetic resonance imaging, nuclear medicine and positron emission tomography) to be accredited beginning January 1, 2010. The accreditation requirement applies to mobile units, physician offices, and IDTFs that create images.
  
• CMS will take into consideration the comments provided on the creation of a group of experts separate from the AMA RUC, to help the agency improve the review of RVUs. Any revisions to this process would be discussed in future rulemaking.
  
• CMS is carefully considering options and taking an iterative approach to plan development of the Value-Based Purchasing program for physicians and other practitioners.

National payment rates for heart rhythm services and procedures — The Society's staff is currently updating the National rate with the new conversion factor (as described in the December 10 Federal Register notice)

Taking all changes in the final rule into account, CMS projects that payments to primary care providers will increase between 5 to 8 percent, prior to application of the negative 21.2 percent update.

The Heart Rhythm Society will continue to work with other cardiovascular medical societies to express our opposition to the use of the PPIS data to Capitol Hill, to the Obama Administration and to CMS. The Society will keep you informed of these activities and will continue to analyze the impact of the final rule.