The Centers for Medicare and Medicaid Services (CMS) recently released the 2017 Medicare Physician Fee Schedule (MPFS) final rule. All policies and payments are effective on January 1, 2017. The MPFS specifies payment rates to physicians and other providers, as well as technical payments for freestanding cancer centers. It does not apply to hospital outpatient departments, which is covered under a separate rule whose changes are described in a separate article below.
CMS identified several radiation oncology codes as being "potentially misvalued". These codes were revalued by the AMA Relative Value Scale Update Committee (RUC) and payment will be reduced in 2017. Impacted codes include 2 for treatment device (77332, 77334), the special treatment procedure (77470) and 4 for hyperthermia treatment (77600, 77605, 77610, 77615). The technical and global payment for the intermediate treatment device (77333) code will increase in 2017. The AAPM successfully persuaded CMS to increase the physician work value for complex interstitial brachytherapy (77778) from 8.00 to 8.78 relative value units (RVUs).CMS's new rule establishes values for new moderate sedation codes and implements a uniform method for valuing codes for procedures that currently include moderate sedation. Specifically, CMS reduces the work RVU for radiation oncology procedures 77371, 77600, 77605, 77610 and 77615 by 0.25 RVUs. The reduction in work RVUs will be offset by the physician work of the new moderate sedation codes, when it is provided. Other 2017 proposals that impact radiology and radiation oncology payment include:
Overall, the final rule has minimal impact on payments to radiation oncologists, radiologists, and freestanding cancer centers.
To read a complete summary of the final rule and to review impact tables go to the AAPM website.
The Centers for Medicare and Medicaid Services (CMS) recently released the 2017 Hospital Outpatient Prospective Payment System (HOPPS) final rule with an effective date of January 1, 2017.
CMS reduced the number of ambulatory payment classifications (APCs) for Therapeutic Radiation Treatment Preparationfrom 4 to 3 levels. Three reassigned codes, including the special medical physics consultation code (77370), have a significant payment decrease of 30%. Final 2017 payments and impacts for radiation oncology procedures are in the table below.
2017 RADIATION ONCOLOGY HOPPS PAYMENTS | |||||
---|---|---|---|---|---|
APC | Description | CPT Codes | 2016 Payment | 2017 Payment | Percentage Change 2016-2017 |
5092* | Level 2 Breast/ Lymphatic Surgery and Related Procedures | 19298 & other breast surgery codes | $7,557.75 | $4,417.60 | -41.5% |
5093* | Level 3 Breast/ Lymphatic Surgery and Related Procedures | 19296 & other breast surgery codes | $7,557.75 | $6,483.61 | -14.2% |
5611 | Level 1 Therapeutic Radiation Treatment Preparation | 77280, 77299, 77300, 77316, 77331, 77332, 77333, 77336, 77370, 77399 | $107.40 | $117.53 | 9.4% |
5612 | Level 2 Therapeutic Radiation Treatment Preparation | 77280, 77299, 77300, 77316, 77331, 77332, 77333, 77336, 77370, 77399 | $291.77 | $311.43 | 6.7% |
5613 | Level 3 Therapeutic Radiation Treatment Preparation | 32553, 49411, 55876, 77295, 77301, C9728 | $1,026.81 | $1,065.79 | 3.8% |
5621 | Level 1 Radiation Therapy | 77401, 77402, 77407, 77789, 77799 | $110.34 | $114.30 | 3.6% |
5622 | Level 2 Radiation Therapy | 77412, 77600, 77750, 77767, 77768, 0394T | $194.35 | $204.42 | 5.2% |
5623 | Level 3 Radiation Therapy | 77385, 77386, 77422, 77423, 77470, 77520, 77610, 77615, 77620, 77761, 77762 | $505.51 | $492.42 | -2.2% |
5624 | Level 4 Radiation Therapy | 77605, 77763, 77770, 77771, 77772, 77778, 0395T | $696.21 | $738.32 | 6.0% |
5625 | Level 5 Radiation Therapy | 77522, 77523, 77525 | $1,150.69 | $993.70 | -13.6% |
5626 | Level 6 Radiation Therapy | 77373 | $1,671.91 | $1,650.59 | -1.3% |
5627* | Level 7 Radiation Therapy | 77371, 77372, 77424, 77425 | $7,300.24 | $7,452.84 | 2.1% |
8001 | LDR Prostate Brachytherapy Composite | 55875 and 77778 on the same day | $3,385.44 | $3,498.77 | 3.3% |
CMS finalized their proposal to create 25 new Comprehensive APCs, many which include brachytherapy related surgical procedures (20555, 41019, 55920, 57155, 58346), which are converted from a clinical APC to a Comprehensive APC in 2017. This may have implications for brachytherapy treatment delivery since Comprehensive APCs make a single payment for the primary surgical procedure and bundle all other costs, including radiation treatment planning and delivery codes, on the same claim. AAPM did an economic analysis of the new Comprehensive APC claims data and determined that some costs of associated radiation therapy services, including brachytherapy treatment delivery, were not captured in the bundled payment.
CMS replied that they rely on hospitals to bill all codes accurately in accordance with their code descriptors and CPT and CMS instructions, as applicable, and to report charges on claims and charges and costs on their Medicare hospital cost reports appropriately.
Moreover, CMS stated that they do not remove claims from the claims accounting when stakeholders believe that hospitals included incorrect information on some claims.
CMS may examine the claims for these brachytherapy insertion codes and determine if any future adjustment to the methodology (or possibly code edits) would be appropriate.Other 2017 HOPPS policies include:A complete summary of the final rule and impact tables is on the AAPM website.
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