Emergency Update to the 2005 Medicare Physician Fee Schedule Database (MPFSDB)

Provider Types Affected
Physicians and practitioners billing Medicare carriers

Provider Action Needed
Physicians and practitioners should note there are changes to the 2005 MPFSDB. The new fees are posted on the Medicare carriers’ Web sites.

Background
MPFSDB files were issued to carriers based upon the November 15, 2004, Medicare Physician Fee Schedule Final Rule. These are the fees that are on the CDs that were recently mailed to all physicians as part of the annual participation enrollment process. However, the Centers for Medicare & Medicaid Services (CMS) has made a few changes to that database. These include changes to a few CPT codes with respect to status indicators, global periods, and the addition of 12 demonstration codes (G9021-G9032) for use with chemotherapy infusion. A new MPFSDB file was released to carriers and this new MPFSDB file will be posted to your local carrier’s Web site. Physicians and practitioners should refer to their local carrier’s Web site to view the new updated fees.

Implementation
The implementation date for the new fees is January 3, 2005. However, the new fees will be available on your Medicare carrier’s Web site before January 1.

Additional Information
The specific changes to the fee schedule are identified in an attachment to the instructions issued to your carrier. Those instructions are CR 3595 and they may be viewed by going to: http://www.cms.hhs.gov/Transmittals/

Once at that page, scroll down the CR NUM column on the right looking for CR 3595, then click on the file for that CR.

If you have any questions regarding this issue, please contact your carrier at their toll-free number, which may be found at: http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf

Disclaimer
Medlearn Matters articles are prepared as a service to the public and are not intended to grant rights or impose obligations. Medlearn Matters articles 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 Empire Medicare Services
MPFSDB Fee Changes:

Important Medicare Part B New Jersey News
Medlearn Matters…Information for Medicare Providers (Issued by the Centers for Medicare & Medicaid Services)
New York					New Jersey					Code	Area	Par Fee	Non-Par	Lmt. Chrg	Code	Area	Par Fee	Non-Par	Lmt. Chrg	37195	01	N/A	N/A		37195	01	N/A	N/A		37195	02	N/A	N/A		37195	99	N/A	N/A		37195	03	N/A	N/A							77418	01	911.59	866.01	995.91	77418	01	829.07	787.62	905.76	77418	02	873.36	829.69	954.14	77418	99	766.24	727.93	837.12	77418	03	739.20	702.24	807.58

N/A = This code is carrier-priced. Fee not yet established.

Related Change Request (CR) #: 3595
Medlearn Matters Number: MM3595

Related CR Release Date: December 23, 2004
Related CR Transmittal #: 414

Effective Date: January 1, 2005
Implementation Date: January 3, 2005

Posted: 12/30/2004