2009 Proposed Rule for the
Medicare Physician Fee
Schedule (MPFS)
On June 30, the Centers for Medicare & Medicaid Services
(CMS) released its MPFS proposed rule for fiscal year 2009.
The proposed rule calls for a decrease in Medicare payments
to physicians by 5.4% as a result of the sustainable
growth rate formula (SGR). The rule was published in the
Federal Register on July 7. Comments will be accepted until
August 29. The final rule will be published by November 1.
Provisions will be implemented January 1, 2009.
Please note that legislation pending at this writing may
change the above percentage in the fee schedule.
Key highlights of the proposed MPFS rule include:
Expansion of Multiple Diagnostic Imaging
Procedure Payment Reduction
The rule adds ten new procedures to the list of procedures
subject to the 25% reduction of the technical component
(-TC) of second and subsequent procedures done on
contiguous body parts in the same imaging session. The
following are the new codes and the respective family:
| Code |
Short Descriptor |
Code Family |
| 70336 |
MRI, temporomandibular joint(s) |
Family 5 MRI and MRA (Head/Brain/Neck) |
| 70554 |
FMRI brain by tech |
Family 5 MRI and MRA (Head/Brain/Neck) |
| 75557 |
Cardiac MRI for morph |
Family 4 MRI and MRA (Chest/Abd/Pelvis) |
| 75559 |
Cardiac MRI w/stress img |
Family 4 MRI and MRA (Chest/Abd/Pelvis) |
| 75561 |
Cardiac MRI for morph w/dye |
Family 4 MRI and MRA (Chest/Abd/Pelvis) |
| 75563 |
Cardiac MRI w/stress img & dye |
Family 4 MRI and MRA (Chest/Abd/Pelvis) |
| 76776 |
US exam k transpl w/doppler |
Family 1 ultrasound (Chest/Abdomen/Pelvis – Non-Obstetrical) |
| 76870 |
US exam, scrotum |
Family 1 ultrasound (Chest/Abdomen/Pelvis – Non-Obstetrical) |
| 77058 |
MRI, one breast |
Family 4 MRI and MRA (Chest/Abd/Pelvis) |
| 77059 |
MRI, both breasts |
Family 4 MRI and MRA (Chest/Abd/Pelvis) |
New Quality and Performance Standards
for Physicians
CMS is proposing that diagnostic imaging (except mammography)
be performed in enrolled Independent Diagnostic Testing
Facilities (IDTFs) and subject to the same rules such as
supervision by a “qualified physician”. CMS’ goal is to improve
the quality of in-office diagnostic testing performed by physicians
and non-physician practitioners (NPPs) by requiring them
to enroll as suppliers of these services to meet certain quality
and performance standards, including applicable Federal and
State licensure, health, and safety requirements that currently
apply to IDTFs. CMS is proposing to make the standards effective
January 1, 2009 for newly enrolling suppliers, but to allow
existing suppliers until September 30, 2009.
Payment for Radiopharmaceuticals and
Contrast Agents
There are no changes to the radiopharmaceutical payment
methodology for the physician office or IDTF setting for 2009.
Drugs, contrast agents and biologicals will continue to be paid
at 106% of the average sales price (ASP+6).
For more information about the proposed MPFS, please visit
http://www.cms.hhs.gov/PhysicianFeeSched/PFSFRN/list.asp#TopOfPage
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