2008 Medicare Physician Fee Schedule (MPFS) and the Telehealth Originating Site Facility Fee Payment Amount: Summary of Policies
Provider Action Needed
This article is based on Change Request (CR) 5895 which contains summaries of the policy changes in the 2008 Medicare Physician Fee Schedule and the telehealth originating site facility fee for 2008.
Note: This CR does not include any changes that would be affected by recent legislation. For example, 0.5 percent update to the conversion factor, changes to the geographic practice cost indices floor, etc. Information regarding these changes can be found in CR 5944, Legislative Change Affecting the 2008 Medicare Physician Fee Schedule (MPFS) and Extension of the 2008 Participation Open Enrollment Period.
Background
The Social Security Act, Section 1848(b)(1), requires the Centers for Medicare & Medicaid Services (CMS) to provide (by regulation before November 1 of each year) fee schedules that establish payment amounts for physicians' services for the subsequent year. CMS published a document that will affect payments to physicians effective January 1, 2008.
The Social Security Act, Section 1834(m), established the payment amount for the Medicare telehealth originating site facility fee for telehealth services provided from October 1, 2001, through December 21, 2002 at $20.
For telehealth services provided on or after January 1 of each subsequent calendar year, the telehealth originating site facility fee is increased as of the first day of the year by the percentage increase in the Medicare Economic Index (MEI) as defined in the Social Security Act, Section 1842(i)(3). The MEI increase for 2008 is 1.8 percent.
For calendar year 2008, the payment amount for HCPCS code Q3014 (Telehealth originating site facility fee) is either 80 percent of the lesser of the actual charge or $23.35.
Note: The beneficiary is responsible for any unmet deductible amount or coinsurance.
In summary, CR 5895 instructs your Medicare contractor to:
- Pay for the Medicare telehealth originating site facility fee as described by HCPCS code Q3014 at 80 percent of the lesser of the actual charge or $23.35
- Consider payment for the following HCPCS codes only when appropriate, reasonable and necessary (e.g., when the service is provided to evaluate patients with signs/symptoms of illness or injury) as per of the Social Security Act, Section 1862(a)(1)(A):
| HCPCS Code | Descriptor |
| G0396 |
Alcohol and/or substance (other than tobacco) abuse structured assessment (eg, AUDIT, DAST) and brief intervention, 15 to 30 minutes. |
| G0397 |
Alcohol and/or substance (other than tobacco) abuse structured assessment (eg, AUDIT, DAST) and intervention greater than 30 minutes. |
See the attachment to CR 5895 (PDF, 246 KB) for:
- A summary of significant issues discussed in CMS-1325-FC, Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, and Other Part B Payment Policies for CY 2008; Revisions to the Payment Policies of Ambulance Services Under the Ambulance Fee Schedule for CY 2008; and the Amendment of the E-Prescribing Exemption for Computer-Generated Facsimile Transmissions
Additional Information
See the official instruction, CR5895 (PDF, 246 KB).
If you have any questions, please contact our office at (866) 332-7025.