Medicare Fee Schedule Update

Medicare Fee Schedule Update Effective October 1, 2006

CPT Code 47145—change in global days.

Medicare announced on September 5, 2006 a change in the Medicare Fee Schedule for CPT code 47145. Medicare changed the global days from 90 days to XXX, which means the global concept does not apply.

In with the new…

This change means the CPT code 47145, Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; with lobe split of whole liver graft into two partial liver grafts [i.e., left lobe (segments II, III, and IV) and right lobe (segments I and V through VIII)] no longer has a 90 day global period for the surgeon who performs this work.

CPT Codes 15000 and 15001

Medicare announced a change in the status code for Assistant Surgeon services effective 10/1/06. Currently, Medicare will not pay for an Assistant Surgeon for these 2 procedures. Effective 10/1/06, Medicare has assigned the status code of “0”. Payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity. This means if the primary surgeon documents the medical necessity of the involvement of an Assistant Surgeon on procedures defined by 15000 and 15001, and sends supportive documentation, Medicare will consider reimbursing the Assistant Surgeon.

HCPCS Code G0289 (Arthroscopy, Knee, Surgical, For Removal Of Loose Body, Foreign Body, Debridement/shaving Of Articular Cartilage (chondroplasty) At The Time Of Other Surgical Knee Arthroscopy In A Different Compartment Of The Same Knee).

Medicare announced on September 5, 2006 a change in the Medicare Fee Schedule for HCPCS Code G0289. Medicare changed the multiple surgery payment indicator from a "2" to a "0". This means Medicare is again recognizing the "add-on" status of this code and will allow payment at the fee schedule amount.

In with the new…

The payment status code of "0" states, "No payment adjustment rules for multiple procedures apply. If the medical procedure is reported on the same day as another procedure, payment is based on the lower of actual charges or fee schedule amount."

Out with the old...

The payment status code of "2" (which is no longer effective as of 10/1/06) states, "Standard payment adjustment rules for multiple procedures apply. If a procedure is reported on the same day as another procedure with a 1, 2, or 3, rank the procedures by fee schedule and apply the appropriate reduction to this code (100%, 50%, 50%, 50%, 50%, and by report). Base payment on the lower of actual charges or fee schedule amount reduced by the appropriate percentage."

Action Steps:

• Inform physicians and staff of the reversal in payment for this procedure effective 10/1/06

• Make sure staff submits full fees for each procedure performed as Medicare will reimburse the lower of charges submitted or the fee schedule amount. If multiple procedures are reported, submit the fee for each procedure.

• Educate payment posting staff and accounts receivable staff

• Make sure fee schedules are loaded into practice management system if the system has this feature

• If your practice management system does not have fees loaded, create a list of add-on and exempt codes so staff know that payment should be at the fee schedule amount with no multiple procedure reductions

• Monitor EOBs closely!*