The chart below, edited for the blog, appears in the proposed 2011 Medicare Physician Fee Schedule. It illustrates the need for a permanent Medicare payment fix, showing the impact of the sustainable growth rate (SGR) on physician payments over the next six months.
The picture looks bad with payments for high volume services dropping between 2% and 12%, but it's even worse considering the 2010 payments are about 23% less than what is paid today. For example, 99203 (Office/outpatient visit, new) currently pays $99.93, but it's set to pay $76.93 on Dec. 1 and $72.67 on Jan. 1.
Part B News subscribers can see current 2010 Medicare payments along side the December 2010 and January 2011 payments.
|
CPT1/ HCPCS Code
|
MOD
|
Short Descriptor
|
Nonfacility payment
|
|
2010
|
2011
|
Percent Change
|
|
11721
|
|
Debride nail, 6 or more
|
$31.23
|
$29.71
|
-5%
|
|
17000
|
|
Destruct premalg lesion
|
$57.91
|
$55.98
|
-3%
|
|
43239
|
|
Upper GI endoscopy, biopsy
|
$256.05
|
$243.80
|
-5%
|
|
66821
|
|
After cataract laser surgery
|
$228.80
|
$222.69
|
-3%
|
|
67210
|
|
Treatment of retinal lesion
|
$494.21
|
$473.12
|
-4%
|
|
71010
|
|
Chest X-ray
|
$18.17
|
$16.94
|
-7%
|
|
71010
|
26
|
Chest X-ray
|
$7.10
|
$6.38
|
-10%
|
|
77056
|
|
Mammogram, both breasts
|
$82.61
|
$78.08
|
-5%
|
|
77056
|
26
|
Mammogram, both breasts
|
$34.63
|
$30.69
|
-11%
|
|
77057
|
|
Mammogram, screening
|
$61.60
|
$57.45
|
-7%
|
|
77057
|
26
|
Mammogram, screening
|
$27.82
|
$24.80
|
-11%
|
|
77427
|
|
Radiation tx management, x5
|
$153.00
|
$141.17
|
-8%
|
|
88305
|
26
|
Tissue exam by pathologist
|
$28.67
|
$26.03
|
-9%
|
|
90801
|
|
Psy dx interview
|
$120.93
|
$109.75
|
-9%
|
|
90862
|
|
Medication management
|
$44.28
|
$41.00
|
-7%
|
|
92012
|
|
Eye exam established pat
|
$58.48
|
$56.96
|
-3%
|
|
92014
|
|
Eye exam & treatment
|
$85.44
|
$82.74
|
-3%
|
|
93000
|
|
Electrocardiogram, complete
|
$15.61
|
$14.24
|
-9%
|
|
93010
|
|
Electrocardiogram report
|
$ 7.10
|
$ 6.38
|
-10%
|
|
93015
|
|
Cardiovascular stress test
|
$72.67
|
$66.29
|
-9%
|
|
93307
|
26
|
Echo exam of heart
|
$38.32
|
$34.13
|
-11%
|
|
93510
|
26
|
Left heart catheterization
|
$198.71
|
$174.81
|
-12%
|
|
98941
|
|
Chiropractic manipulation
|
$27.25
|
$25.29
|
-7%
|
|
99203
|
|
Office/outpatient visit, new
|
$76.93
|
$72.67
|
-6%
|
|
99213
|
|
Office/outpatient visit, est
|
$51.38
|
$48.86
|
-5%
|
|
99214
|
|
Office/outpatient visit, est
|
$76.93
|
$72.43
|
-6%
|
|
99291
|
|
Critical care, first hour
|
$203.25
|
$187.33
|
-8%
|
|
99292
|
|
Critical care, addÏl 30 min
|
$91.97
|
$83.97
|
-9%
|
|
99348
|
|
Home visit, est patient
|
$63.59
|
$58.19
|
-8%
|
|
99350
|
|
Home visit, est patient
|
$130.58
|
$120.30
|
-8%
|
|
G0008
|
|
Admin influenza virus vac
|
$16.75
|
$16.45
|
-2%
|
|
Payments based upon corrected 2010 conversion factor of $28.3868 under the statute as of October 30, 2009 that would be in effect on December 31, 2010 under current law.
Payments based upon the projected 2011 conversion factor of $26.6574 adjusted by the proposed MEI rescaling factor of 0.921.
|