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Ohio Part B Carrier
2008 Medicare Physician Fee Schedule Database: April 2008 Update

Provider Action Needed
This article is based on Change Request (CR) 5980 which amends payment files previously issued to Medicare contractors based upon the 2008 Medicare Physician Fee Schedule Final Rule. CR 5980 also includes new/revised codes for the Physician Quality Reporting Initiative (PQRI).

Background
Attachment 1 of CR 5980 (PDF, 720 KB) contains changes included in the April Update to the 2008 MPFSDB, and CR 5980 can be reviewed. Specific changes are detailed in Attachment 1 of CR 5980 and are summarized as follows:

CPT/HCPCS code revisions
A number of CPT/HCPCS codes have been modified to reflect revised bilateral indicators, Relative Value Unit (RVU) revisions or procedure status changes retroactive to January 1, 2008.

Reinstated J HCPCS Codes
A number of J HCPCS codes (J7611 through J7614) are reinstated with a status indicator of 'E' and the reinstated codes are effective for dates of service on or after April 1, 2008. Descriptors and payment indicators for the reinstated codes are in attachment 1 of CR 5980.

New Q HCPCS Codes
There are several new Q HCPCS codes (Q4096 through Q4098) with a status indicator of 'E' and which are effective for dates of service on or after April 1, 2008. The codes with their descriptors are in the following table:

HCPCS Code
Long Descriptor
Short Descriptor
Q4096 Injection, Von Willebrand Factor Complex, Human, Ristocetin Cofactor (Not Otherwise Specified), Per I.U. VWF: RCO VWF complex, not Humate-P
Q4097 Injection, Immune Globulin (Privigen),
Intravenous, Non-Lyophilized (E.G., Liquid), 500 mg 		Inj IVIG Privigen 500 mg
Q4098 Injection, Iron Dextran, 50 mg Inj iron dextran
Q4099 Formoterol fumarate, inhalation solution, FDA approved final product, non-compounded, administered through DME, unit dose form, 20
micrograms 		Formoterol fumarate, inh

New Category II Codes for PQRI
There are new Category II codes for the PQRI for dates of service on or after April 1, 2008. These new codes and their descriptors are in the following table:

CPT Code
Long Descriptor
Short Descriptor
0525F Initial visit for episode Initial visit for episode
0526F Subsequent visit for episode Subs visit for episode
1130F Back pain and function assessed, including all of the following: Pain assessment AND functional status AND patient history, including notation of presence or absence of “red flags” (warning signs) AND assessment of prior treatment and response, AND employment status Bk pain + fxn assessed
1134F Episode of back pain lasting six weeks or less Epsd bk pain for =< 6 wks
1135F Episode of back pain lasting longer than
six weeks 		Epsd bk pain for > 6 wks
1136F Episode of back pain lasting 12 weeks or
less 		Epsd bk pain for <= 12 wks
1137F Episode of back pain lasting longer than
12 weeks		 Epsd bk pain for > 12 wks
2040F Physical examination on the date of the initial visit for low back pain performed, in accordance with specifications Bk pn xm on init visit date
2044F Documentation of mental health assessment prior to intervention (back surgery or epidural steroid injection) or for back pain episode lasting longer than six weeks Doc mntl tst b/4 bk trxmnt
3330F Imaging study ordered Imaging study ordered (bkp)
3331F Imaging study not ordered Bk imaging tst not ordered
3340F Mammogram assessment category of
“incomplete: need additional imaging evaluation”, documented 		Mammo assess inc xray
docd
3341F Mammogram assessment category of
“negative”, documented 		Mammo assess negative
docd
3342F Mammogram assessment category of
“benign”, documented 		Mammo assess bengn docd
3343F Mammogram assessment category of
“probably benign”, documented 		Mammo probably bengn
docd
3344F Mammogram assessment category of
“suspicious”, documented 		Mammo assess susp docd
3345F Mammogram assessment category of
“highly suggestive of malignancy”, documented 		Mammo assess hghlymalig
doc
3350F Mammogram assessment category of “known biopsy proven malignancy”, documented Mammo bx proven malig
docd
4240F Instruction in therapeutic exercise with
follow-up by the physician provided to patients during episode of back pain lasting longer than 12 weeks 		Instr xrcz 4bk pn >12 weeks
4242F Counseling for supervised exercise program provided to patients during episode of back pain lasting longer than 12 weeks Sprvsd xrcz bk pn >12
weeks
4245F Patient counseled during the initial visit to
maintain or resume normal activities 		Pt instr nrml lifest
4248F Patient counseled during the initial visit for an episode of back pain against bed rest lasting 4 days or longer Pt instr–no bd rest>= 4 days
4250F Active warming used intraoperatively for the purpose of maintaining normothermia, OR at least one body temperature equal to or greater than 36 degrees Centigrade (or 96.8 degrees Fahrenheit) recorded within the 30 minutes immediately before or the 30 minutes immediately after anesthesia end time Wrmng 4 surg - normothermia
5060F Findings from diagnostic mammogram
communicated to practice managing patient’s on-going care within 3 business days of exam interpretation 		Fndngs mammo 2pt w/in 3
days
5062F Findings from diagnostic mammogram
communicated to the patient within 5 days of exam interpretation 		Doc f2fmammo fndng in 3
days
6040F Use of appropriate radiation dose reduction devices OR manual techniques for appropriate moderation of exposure, documented Appro rad ds dvcs techs
docd
6045F Radiation exposure or exposure time in final report for procedure using fluoroscopy, documented Radxps in end rprt4fluro pxd
7020F Mammogram assessment category
[eg, Mammography Quality Standards Act
(MQSA), Breast Imaging Reporting and Data System (BI-RADS®), or FDA approved equivalent categories] entered into an internal database to allow for analysis of abnormal interpretation (recall) rate 		Mammo assess cat in
dbase
7025F Patient information entered into a reminder system with a target due date for the next mammogram Pt infosys alarm 4 nxt mammo

Revised Descriptors for PQRI Codes
Attachment 1 of CR 5980 also contains a list of editorial changes to the short and/or long descriptors for a number of PQRI codes.

April Update to the 2008 Medicare Physician Fee Schedule Database (MPFSDB)
Effective April 7, 2008, for dates of service performed on or after January 1, 2008, the Centers for Medicare and Medicaid Services (CMS) have made changes to the following CPT codes and CPT codes with HCPCS modifier on the 2008 Medicare Physician Fee Schedule Database (MPFSDB).

The following are revisions to the current MPFSDB: 

NON-FACILITY SETTING
FACILITY SETTING
CPT Code
HCPCS Modifier
State
PAR
NON
PAR
LMT
CHG
#F PAR
#F NON
PAR
#F LMT
CHG
93501
OH
$808.24
$767.83
$883.00
$808.24
$767.83
$883.00
WV
$749.41
$711.94
$818.73
$749.41
$711.94
$818.73
93501
TC
OH
$649.99
$617.49
$710.11
$649.99
$617.49
$710.11
WV
$593.98
$564.28
$648.92
$593.98
$564.28
$648.92
93508
OH
$949.56
$902.08
$1,037.39
$949.56
$902.08
$1,037.39
WV
$872.57
$828.94
$953.28
$872.57
$828.94
$953.28
93508
TC
OH
$725.66
$689.38
$792.79
$725.66
$689.38
$792.79
WV
$653.69
$621.01
$714.16
$653.69
$621.01
$714.16
93510
OH
$1,448.17
$1,375.76
$1,582.12
$1,448.17
$1,375.76
$1,582.12
WV
$1,344.45
$1,277.23
$1,468.81
$1,344.45
$1,277.23
$1,468.81
93510
TC
OH
$1,212.27
$1,151.66
$1,324.41
$1,212.27
$1,151.66
$1,324.41
WV
$1,113.73
$1,058.04
$1,216.75
$1,113.73
$1,058.04
$1,216.75
93526
OH
$1,875.47
$1,781.70
$2,048.96
$1,875.47
$1,781.70
$2,048.96
WV
$1,744.09
$1,656.89
$1,905.42
$1,744.09
$1,656.89
$1,905.42
93526
TC
OH
$1,548.10
$1,470.70
$1,691.31
$1,548.10
$1,470.70
$1,691.31
WV
$1,423.85
$1,352.66
$1,555.56
$1,423.85
$1,352.66
$1,555.56
93642
OH
$484.42
$460.20
$529.23
$484.42
$460.20
$529.23
WV
$457.63
$434.75
$499.96
$457.63
$434.75
$499.96

State = Ohio (OH) and West Virginia (WV), PAR = Participating (Non-Facility Setting) fee schedule amount, NON PAR = Nonparticipating (Non-Facility Setting) fee schedule amount, LMT CHG = Limiting charge applies to the Nonparticipating (Non-Facility Setting) fee schedule amount, #F PAR = Facility Setting Participating fee schedule amount, #F NON PAR = Facility Setting Nonparticipating fee schedule amount, #F LMT CHG = Limiting charge applies to Facility Setting Nonparticipating fee schedule amount. Limiting charge applies to unassigned claims by a nonparticipating provider in or out of a facility setting.

Additional Information
See the official instruction, CR 5980 (PDF, 720 KB), issued to your carrier, FI, and A/B MAC regarding this change.

If you have any questions, please contact our office at (866) 332-7025.

 

last updated on 04/03/2008