Medicare final rule: Little good news for urologists

December 1, 2007

The regulations guiding the Centers for Medicare & Medicaid Services for the establishment of the 2008 physician fee schedule remain unchanged for the most part.

Every November, Medicare is required to publish its final rule for payment of physicians for the next calendar year. The regulations guiding the Centers for Medicare & Medicaid Services for the establishment of the 2008 physician fee schedule remain unchanged for the most part.

The sustainable growth rate and the resource-based relative value scale update schedule limit the number of changes that can be made to the relative values and fix the budget calculation for the development of a conversion factor determining reimbursement rates for the next year. Space does not allow us to address all of the issues related to the final rule in depth, so this article will touch on many important issues specific to urology. The final rule can be viewed at: http://www.cms.hhs.gov/PhysicianFeeSched/PFSFRN/list.asp?listpage=2. (Open document CMS-1385-FC.)

The practice expense phase-in will affect urology most notably with the continued reduction of fees for in-office services such as BPH therapies (~ –10%), cystoscopy surgeries (~ –5%), LHRH injection fee (~ –6%), and catheterization services (~ –3%). Note that a diagnostic cystoscopy and retrograde are not affected by the decrease, and the LHRH injection does not apply to the drug, which is reimbursed under a separate fee schedule.

Under CPT, the phone calls for patient care have been revised into three separate codes with specific times: 99441, 5 to 10 minutes, $12; 99442, 11 to 21 minutes, $22.65; and 99443, 21 to 30 minutes, $33.44. If you calculate this, your time on the telephone to a patient is valued at approximately $67 per hour.

CPT now includes a code for online E&M services (99444). However, Medicare has chosen not to value this code and also considers this to be a bundled service, blocking payment for this service as well. Note: Non-covered services may be billed to the patient without first obtaining an Advance Beneficiary Notice. We continue to check with Medicare regarding the potential to bill patients directly for phone calls and Internet E&M services.