RUC proposes, CMS disposes and the difference could mean a lot of dollars to doctors

by: Julia Kyles, CPC Aug 12, 2019

CMS has painful plans for the somatic nerve block family of codes next year. Proposed cuts to work and other relative value units (RVUs) will result in lower pay for most codes in the 64400-64450 range, DecisionHealth analysis of the proposed 2020 Medicare physician fee schedule reveals.

The AMA’s RVS update committee (RUC) did propose cutting the work RVUs (WRVUs) for most of the codes. But with the exception of six codes, when the RUC went low CMS went lower -- and that would shave even more money off the payments practices receive in 2020. See the chart to understand how the proposed WRVUs change the projected national payments for the services. Codes with the same proposed RUC- and CMS-approved RVUs are marked in bold font.

Practices should “review the direct financial impact as many of the managed care contracts will pay these ancillary services at the CMS RVU rates,” says Devona Slater, CHC, CHA, CMCP, president, Auditing for Compliance and Education, Overland Park, Kan.

The good news is the CMS WRVUs are not set in stone and practices can comment on the proposed WRVUs or any other part of the rule until Sept. 27, 5 p.m., ET. Remember to reference CMS-1715-P.

Code	Description	RUC WRVU	CMS WRVU	2020 NF fee (RUC)	2020 NF fee (CMS)	2020 Fac fee (RUC)	2020 Fac fee (CMS)
64400	N block inj trigeminal	1.00	0.75	$116.57	$107.55	$60.27	$51.25
64405	N block inj occipital	0.94	0.94	$73.62	$73.62	$55.58	$55.58
64408	N block inj vagus	0.90	0.75	$75.79	$70.38	$49.80	$44.39
64415	N block inj brachial plexus	1.42	1.35	$118.37	$115.85	$68.57	$66.04
64416	N block cont infuse b plex	1.81	1.48	N/A	N/A	$79.40	$67.49
64417	N block inj axillary	1.27	1.27	$139.67	$139.67	$63.16	$63.16
64418	N block inj suprascapular	1.10	1.10	$87.34	$87.34	$59.55	$59.55
64420	N block inj intercost sng	1.18	1.08	$105.38	$101.77	$64.96	$61.35
64421	N block inj intercost mlt	0.60	0.50	$38.62	$35.01	$29.95	$26.35
64425	N block inj ilio-ing/hypogi	1.19	1.00	$121.98	$115.13	$64.60	$57.74
64430	N block inj pudendal	1.15	1.00	$98.16	$92.75	$62.80	$57.38
64435	N block inj paracervical	0.75	0.75	$75.43	$75.43	$45.47	$45.47
64445	N block inj sciatic sng	1.18	1.00	$134.61	$128.12	$62.07	$55.58
64446	N blk inj sciatic cont inf	1.54	1.36	N/A	N/A	$68.21	$61.71
64447	N block inj fem single	1.10	1.10	$90.22	$90.23	$54.50	$54.50
64448	N block inj fem cont inf	1.55	1.41	N/A	N/A	$69.65	$64.60
64449	N block inj lumbar plexus	1.55	1.27	N/A	N/A	$75.07	$64.96
64450	N block other peripheral	0.75	0.75	$77.95	$77.95	$43.67	$43.67
Source: DecisionHealth analysis of the proposed 2020 Medicare physician fee schedule

Blog Tags: AMA, CMS, fee schedule

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