2018 Medicare Physician Fee Schedule Final Rule

On November 2, 2017, CMS released CY2018 Medicare Physician Fee Schedule (MPFS) Final Rule that includes policy and payment changes for services provided to Medicare beneficiaries in 2018.  The MPFS final rule will appear in the November 15, 2017 Federal Register, it may be downloaded here.

This communication offers an initial assessment of the changes to the payment rates for Medicare services paid under the Medicare Physician Fee Schedule. The American Society of Echocardiography (ASE) is currently reviewing the details of the proposed rules and will provide a more extensive summary soon.

AUC Mandate: CMS further extended the effective date to January 1, 2020 instead of the proposed 2019.  Medicare received numerous comments and concerns about timing for implementation and staff training requirements.

CY2018 Payment Updates for Echocardiography Services:  As highlighted in the proposed MPFS, this summer CMS identified two TTE codes (93306 and 93351) as “Potentially Misvalued Codes” as determined through a “High Expenditure” screen.  ASE (as part of its role on the AMA House of Delegates) – along with American College of Cardiology – participated in the RUC review of primary transthoracic echocardiography CPT code 93306, stress transthoracic echocardiography CPT code 93351, and the related family of CPT codes.

We are pleased that CMS has accepted the RUC recommendation to increase the wRVUs for CPT code 93306 from 1.30 to 1.50 wRVUs.  Additionally, CMS will maintain the current wRVUs values for remaining transthoracic and stress echocardiography services. Ensuring adequate reimbursement levels for echocardiography services on behalf of our ASE provider members ultimately helps provide patient access to this important technology.

ASE is incredibly proud of the work both the ASE and ACC RUC teams – Dr. Main, Dr. Rose, Dr. Wright, Dr. Waites, Dr. Picard, Dr. Wiegers, Dr. Wiener and Dr. Klein – did to achieve this outcome. Most especially we would like to thank all our members that took time out of their busy schedules to complete the RUC survey to ensure a fair and accurate valuation for all physician services that guarantees access to quality care.

Below is a chart highlighting the physician work values for echocardiography services beginning January 1, 2018.

 

CPT Code Descriptor  2017 wRVU  Final 2018 wRVU Variance Final 2017-2018 wRVU % Change                2017-2018 wRVU
Transthoracic Echocardiography    
93303 Echo transthoracic  1.30  1.30  – 0%
93304 Echo transthoracic  0.75  0.75  – 0%
93306 TTE w/Doppler complete  1.30  1.50  0.20 13%
93307 TTE w/o Doppler complete  0.92  0.92  – 0%
93308 TTE f-up or lmtd  0.53  0.53  – 0%
Transesophageal Echocardiography    
93312 Echo transesophageal  2.30  2.30  – 0%
93313 Echo transesophageal  0.26  0.26  – 0%
93314 Echo transesophageal  1.85  1.85  – 0%
93316 Echo transesophageal  0.60  0.60  – 0%
93355 Echo transesophageal (TEE) 4.66 4.66 0%
Doppler Add-on Codes    
93320 Doppler echo exam heart  0.38  0.38  – 0%
93321 Doppler echo exam heart  0.15  0.15  – 0%
93325 Doppler color flow add-on  0.07  0.07  – 0%
Stress Transthoracic Echocardiography    
93350 Stress TTE only  1.46  1.46  – 0%
93351 Stress TTE complete  1.75  1.75  – 0%
93352 Admin Echo contrast agent  0.19  0.19  – 0%

 

CMS finalized increase to echo code 93306 and accepted the cardiology community’s proposal that prevents cuts to echoes with contrast