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New Guidance – Medicare Physician Fee Schedule

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Some changes you’ll find in the April 2016 update actually went into effect the first of the year.

They are:

HCPCS Level II code G0464 Colorectal cancer screening; stool-based DNA and fecal occult hemoglobin (e.g., kras, ndrg4 and bmp3) is now assigned a procedure status of I Not valid for Medicare purposes. Medicare uses another code for reporting of, and payment for, these services. (Code not subject to a 90 day grace period)

CPT 10030 is now assigned global period days of 000 Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable.

CPT 77014 is now assigned a PC/TC indicator of 1 Diagnostic tests/radiology services. These codes generally have both a professional and technical component. Modifiers 26 and TC can be used with these codes.

CPT 80055 is now assigned a procedure status of X Statutory exclusion. These codes represent an item or service that is not in the statutory definition of “physician services” for fee schedule payment purposes. No RVUs or payment amounts are shown for these codes and no payment may be made under the physician fee schedule. (Examples are ambulances services and clinical diagnostic laboratory services.)

Medicare administrative contractors will not search their files to either retract payment for claims already paid or retroactively pay claims. It is the responsibility of the healthcare provider to correct claims for these codes.

Effective for services performed on or after April 1, 2016:

G9678 is assigned a procedure status of X

G9481 (Remote E/M new patient 10 mins) has a PE RVU = 0, all other MPFS indicators/values = 99201

G9482 (Remote E/M new patient 20 mins) has a PE RVU = 0, all other MPFS indicators/values = 99202

G9483 (Remote E/M new patient 30 mins) has a PE RVU = 0, all other MPFS indicators/values = 99203

G9484 (Remote E/M new patient 45 mins) has a PE RVU = 0, all other MPFS indicators/values = 99204

G9485 (Remote E/M new patient 60 mins) has a PE RVU = 0, all other MPFS indicators/values = 99205

G9486 (Remote E/M est. patient 10 mins) has a PE RVU = 0, all other MPFS indicators/values = 99212

G9487 (Remote E/M est. patient 15 mins) has a PE RVU = 0, all other MPFS indicators/values = 99213

G9488 (Remote E/M est. patient 25 mins) has a PE RVU = 0, all other MPFS indicators/values = 99214

G9489 (Remote E/M est. patient 40 mins) has a PE RVU = 0, all other MPFS indicators/values = 99215

G9490 (Joint replace mod home visit) with all MPFS indicators & RVUs = those of G9187.

Codes G9481-G9490 are new and are assigned Type of Service 1 Medical care.

Source: MLN Matters MM9531