Appendix E
2000 Fact Sheet

Revisions to the 2000 Medicare Physician Fee Schedule affect the amount you will receive when providing services to a Medicare beneficiary. Below is a summary of the major changes effective January 1, 2000.

Physician Practice Expense Relative Value Units (RVUs)

Practice expense RVUs for Calendar Year (CY) 2000 have been revised to reflect the continuing implementation of new resource based practice expense RVUs required by the Balanced Budget Act of 1997.

Malpractice Expense RVUs

HCFA has established new resource-based malpractice expense RVUs as required by the Balanced Budget Act of 1997. The malpractice payments for the 2000 Medicare Physician Fee Schedule represent about 3.2 percent of the physician payments. This method is based upon specialty level malpractice premium data.

Screening Mammography

Screening mammography services are billed using code 76092 and diagnostic mammography services are billed using code 76091. The physician fee schedule contains the maximum allowable amount for 76091. However, the same payment rules do not apply for 76092. The allowable amount for 76092 is the lowest of the actual charge, the statutory cap, or the physician fee schedule amount. The year 2000 update for the cap is 2.4 percent. Therefore, the payment limit for 2000 is: $67.81 for the global procedure; $21.69 for the professional component; and $46.12 for the technical component.

Prostate Cancer Screening

Medicare provides coverage for annual prostate cancer screening tests for men over 50. This screening consists of a digital rectal examination (DRE) and a prostate-specific antigen (PSA) blood test. HCPCS code, G0102, has been established to bill for the screening DRE. G0102 is assigned the same value as 99211, the lowest level evaluation and management (E&M) service. A DRE that is provided on the same day as a covered E&M service is bundled into the payment for the E&M service. If the DRE is the only service provided or is provided as part of an otherwise noncovered service, such as code 99397 for a preventive service visit, then code G0102 could be separately payable. HCPCS code G0103 is used when billing for the screening PSA test. This code is priced at the same payment level as code 84153 and is paid under the clinical diagnostic laboratory fee schedule.

Anesthesia Time

Medicare directs that the allowance for anesthesia services is based on the sum of base units plus time units, multiplied by a locality-specific anesthesia conversion factor. Medicare’s payment policy regarding time units requires the continuous actual presence of the physician or of the medically directed anesthetist and starts when the anesthesiologist or certified registered nurse anesthetist (CRNA) begins to prepare the patient for anesthesia care and ends when the anesthesiologist or CRNA is no longer in personal attendance; that is when the patient may be safely placed under post-operative care. However, Medicare recognizes that there may be a break in anesthesia due to technique used, delay of surgeon, etc. Thus, Medicare’s payment policy is revised to allow anesthesiologists and CRNAs to sum up blocks of time around a break in continuous anesthesia care.

Payment for Diagnostic Tests (Physician Supervision Requirements)

Medicare will allow Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs) and Physician Assistants (PAs) to perform diagnostic services as allowed under State law. Medicare will not allow these practitioners to serve as the supervising physician for an independent diagnostic testing facility.

Elimination of X-Ray Requirement for Chiropractic Services

Medicare has revised the coverage policy for chiropractors that are treating subluxation of the spine. Chiropractors are no longer required to demonstrate the subluxation by x-ray.

Nurse Practitioner Qualifications

Qualifications for NPs established in the 1999 Physician Fee Schedule Regulation unintentionally disqualifies many NPs who are providing services to Medicare beneficiaries. HCFA delayed implementation of the qualification requirements. In the 2000 Physician Fee Schedule regulation, HCFA has corrected this unintentional disqualification by establishing a grandfather provision.
Effective January 1, 2001, an NP requesting a Medicare billing number must possess a State license and national certification. Effective January 1, 2003, an NP requesting a Medicare billing number must possess State licensure, national certification, and a master’s degree.

Physician Assisted Suicide

The Assisted Suicide Funding Restriction Act of 1997 prohibits the use of appropriated funds to provide or pay for any health care item or service or health benefit coverage for the purpose of causing, or assisting to cause, the death of any individual. The list of programs to whom the prohibition applies includes the Medicare program.

Ventricular Assist Devices

Codes 33975 and 33976 will not have a global period for services paid for CY 2000.

Use of Operating Microscope (Code 69990)

HCFA will pay separately for this procedure only when billed with certain primary procedure codes. The codes are: 61304 through 61711, 62010 through 62100, 63081 through 63308, 63704 through 63710, 64831, 64834 through 64836, 64840 through 64858, 64861 through 64870, 64885 through 64898, and 64905 through 64907.

Percutaneous Thrombectomy of an Arteriovenous Fistula

HCFA has established code G0159 for the use of providers that are providing percutaneous thrombectomy of a dialysis graft or fistula.

Practice Expense for Physician Interpretation of Pap Smears

HCFA has revalued the following codes for billing of a physician interpretation of a pap smear: G0124, P3001 and G0141. These codes are now identical in value to code 88141 (also a pap smear procedure that requires interpretation by a physician).