National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

October Update to the 2007 Medicare Physician Fee Schedule Database

MLN Matters Number: MM5714
Related Change Request (CR) #: 5714
Related CR Release Date: August 30, 2007
Effective Date: January 1, 2007
Related CR Transmittal #: R1326CP
Implementation Date: October 1, 2007

Provider Types Affected
Physicians and other providers who bill Medicare contractors (carriers, fiscal intermediaries, or Medicare Administrative Contractors (MAC)) for professional services paid under the MPFS

What You Need to Know
CR5714, from which this article was taken, amends the payment files previously issued to your Medicare contractor (based upon the December 1, 2006, Medicare Physician Fee Schedule (MPFS) Final Rule); and includes new codes for the Physician Quality Reporting Initiative.

Background
Section 1848(c)(4) of the Social Security Act authorizes the Secretary to establish ancillary policies necessary to implement relative values for physicians’ services. Medicare contractors, in accordance with the Medicare Claims Processing Manual, Chapter 23, Section 30.1, give providers 30 days notice before implementing the revised payment amounts and the changes identified in CR5714, which (unless otherwise stated in the CR5714) will be retroactive to January 1, 2007.

You should be aware that carriers will adjust claims that you bring to their attention, but are not required to search their files to either retract payment for claims already paid or to retroactively pay claims. The changes made as a result of CR5714 are as follows:

Changes included in the October Update to the 2007 Medicare Physician Fee Schedule Database are as follows:

The following changes are retroactive to January 1, 2007:

As stated in Transmittal 1301, dated July 20, 2007, (Change Request 5665 -- Revised Information on PET Scan Coding), effective January 28, 2005, CPT code 78609 became a noncovered service for Medicare purposes.

*Effective for dates of service on or after January 28, 2005

New Category II codes for the Physician Quality Reporting Initiative (PQRI)

Effective for dates of service on or after October 1, 2007, the following Category II codes will be added to the MPFS with a status indicator of “M.”

The payment indicators are identical for all of the above PQRI CPT codes and those indicators are as follows:

*Effective for services performed on or after October 1, 2007

The short descriptor for G8370 was listed incorrectly in Transmittal 1258, dated May 29, 2007 (Change Request 5614 – July Update to the 2007 Medicare Physician Fee Schedule Database). The short descriptor has been corrected to read:

Additional Information

You can find the official instruction about the October update to the 2007 Medicare Physician Fee Schedule Database by going to CR5714, located at http://www.cms.hhs.gov/Transmittals/downloads/R1326CP.pdf on the CMS Web site.

If you have any questions, please contact your carrier, FI or MAC at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS Web site.

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

Additional Information Provided by National Government Services
** The new rates for Current Procedural Terminology (CPT) code 54150 (Circumcision), for each carrier locality, will be available on the Centers for Medicare & Medicaid Services (CMS) Web site effective October 1, 2007. The rates can be accessed at http://www.cms.hhs.gov/pfslookup/02_PFSsearch.asp .