AANEM News Express

AANEM News Express

2015 Fee Schedule—What Does This Mean for Reimbursement?

11/18/2014
 
On October 31, 2014, the Center for Medicare and Medicaid Services (CMS) released the Final Rule for the 2015 Medicare Physician Payment Schedule. This document and addendum includes updates to the relative value units (RVU) for all medical procedures. RVUs are calculated by combining work, practice expense (PE), and malpractice (MP) RVUs. They are multiplied by the proposed Medicare conversion factor to come up with the dollar amount for each procedure.

Following is a summary of some of the changes affecting reimbursement for AANEM members for the calendar year (CY) 2015.
  • CPT Codes 62310 (Injection of spine; cervical or thoracic) and 62311 (Injection of spine; lumbar or sacral) reverted  to their CY 2013 values, which results in a 54.9% and 51.8% increase, respectively, over their 2014 values. To avoid overestimating the resources used in furnishing the overall services for these codes, CMS proposes prohibiting the billing of image guidance codes in conjunction with these epidural injection codes. CMS will gather additional data on these codes in CY 2015 to determine the best way to value them through codes that include both the injection and the image guidance.  
  • Work RVUs for all electrodiagnostic and neuromuscular codes monitored by AANEM remained unchanged for CY 2015, with the exception of codes 62310 and 62311 as referenced above. Please visit our website for the complete list of applicable codes.
  • For CY 2015, CMS proposes implementing the third comprehensive review and update of MP RVUs which is required at least every 5 years. Visit the AANEM website for more information on how these adjustments will affect MP RVUs.
  • Chemodenervation codes (64642-64647) saw small reimbursement increases due to slightly increased PE and MP RVUs. Increases ranged from 2.0% to 2.75%.
  • Nerve Conduction Study (NCS) codes 95907-95911 (1-10 studies) saw small increases in reimbursement ranging from 2.9%-6.8%. NCS codes 95912 (11-12 studies) and 95913 (13 or more studies) received minor downward adjustments of -1.4% and -3.1%, respectively.
  • The conversion factor for CY 2015 is $35.8013, down $0.0215 from the conversion factor of $35.8228 utilized in CY 2014. This conversion factor takes into account the zero percent update through March 31, 2015, provided by The Protecting Access to Medicare Act of 2014 and budget neutrality adjustments necessary from policy changes for CY 2015.
  • If Congress does not act before  April 1, 2015, to avert sustainable growth rate (SGR) cuts, the Medicare conversion factor for the balance of CY 2015 (April 1 through December 31, 2015) will be subject to a  negative 21.2% update, for a  a conversion factor of $28.2339
For a complete analysis of CY 2015 RVU adjustments to electrodiagnostic and neuromuscular medicine specific codes, please visit our website here.

AANEM will continue to monitor reimbursement changes, informing our members of them as they occur. If you would like to support our continuing advocacy efforts, consider donating to the Advocacy Fund here.


View Related News Stories:

  CodingReimbursementMedicare


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