Physician Fee Schedule Updates and Policy Changes for Calendar
Year 2000: Final Rule, Nov 2, 1999
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Related Resources
AAMC Documents
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Current Status as of November 17, 1999
On November 2, 1999, the Health Care Financing Administration
(HCFA) published its final rule for revising the Medicare
Physician Fee Schedule for Calendar Year 2000. The AAMC submitted
comments on the proposed
rule, published July 22, on September 20.
Summary
HCFA's final rule announces
the 2000 physician fee schedule dollar conversion factor to
be $36.61 services and the 2000 anesthesia conversion factor
to be $17.77. The overall physician fee schedule update is 5.5
percent, effective January 1.
In addition to the update, the final rule contains the following
new or revised policies that were proposed by HCFA last July
and described in the AAMC summary and
analysis of the proposed rule:
- Implementation of resource-based malpractice insurance
relative value units (RVUs);
- refinement of resource-based practice expense RVUs;
- payment for physician pathology and independent laboratory
services;
- discontinuous anesthesia time;
- use of CPT modifier -25;
- qualifications for nurse practitioners;
- payment of percutaneous thrombectomy of an arteriovenous
fistula;
- bundling of payments for pulse oximetry, temperature gradient
studies, and venous pressure determinations into other services;
- coverage of prostate cancer screening tests;
- clarification of policy for the supervision of diagnostic
tests by nurse practitioners, certified nurse specialists
and physician assistants;
- elimination of global fee period for ventricular assist
device implantations; and
- use of operating microscope (69990).
One of the more controversial provisions of the proposed
rule in July was the proposal to continue the transition to
year 2 of the new resource-based practice expense methodology.
In year 2, HCFA will eliminate the time of a physician's own
clinical staff spent in the hospital setting from inclusion
as a cost of practice in the calculation of the new resource-based
practice expense relative value units. The AAMC continues
to advocate inclusion of clinical staff time as a legitimate
practice expense and a delay in the transition to the new
resource-based system until further refinements are completed.
The final rule restates and implements the provisions of
the proposed rule with a few changes:
Regarding payment for physician pathology and independent
laboratory services, HCFA will begin to pay only hospitals
for the technical component (TC) of services furnished to
its inpatients until January 1, 2001 to allow independent
laboratories and hospitals sufficient time to renegotiate
arrangements.
HCFA will include surgical procedures with a global period
of "XXX" in the application of the global surgery
payment policy relating to the use of modifier -25. This policy
states that for a physician to bill for a separate visit service,
the physician must document the visit as being significant
and separately identifiable from the procedure, and add modifier
-25 to the procedure code. To facilitate implementation of
the policy, HCFA will identify specific codes where an E/M
service is routinely furnished with that code.
Regarding coverage of prostate cancer screening tests, payment
will not be made for a screening PSA blood test performed
for a man age 50 or younger.
Regarding the proposal to discontinue separate payment for
pulse oximetry, etc. HCFA will bundle payment for these services
starting in 2000 with the exception of 94762 which will continue
to be paid for separately when continuous overnight monitoring
is medically necessary as a separate procedure.
Addendum B of the final rule contains the revised relative
value units for all services paid under the fee schedule that
become effective January 1, 2000.
AAMC Action
The AAMC prepared a detailed summary
and analysis of the July 22 proposed rule. The proposed
rule and final rule are available in text format and Portable
Document Format.
Contacts
Denise Dodero, Associate Vice President
AAMC Health Care Affairs
ddodero@aamc.org
(202) 828-0493
Medicare, Physician Fee Schedule, Calendar Year 2000
Final Rule:
- Part I [pp. 59379-59428]: Text
/ PDF
- Part II [pp. 59429-59478]: Text
/ PDF
- Part III [pp. 59479-59528]: Text
/ PDF
- Part IV [pp. 59529-59578]: Text
/ PDF
- Part V [pp. 59579-59590]: Text
/ PDF
Proposed Rule:
- Part I [pp. 39607-39656]: Text
/ PDF
- Part II [pp. 39657-39706]: Text
/ PDF
- Part III [pp. 39707-39756]: Text
/ PDF
- Part IV [pp. 39757-39771]: Text
/ PDF
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