United Healthcare has recently announced a policy change. Effective January 1, 2023, UHC will no longer cover home- and self-administered subcutaneous allergen immunotherapy. The AAOA, in conjunction with AAOHNS, is working to try to reverse this policy change. In the meantime,…
AAOA Member Advocacy Update: Medicare Physician Fee Schedule (MPFS) 2018
The Centers for Medicare & Medicaid Services (CMS) released the proposed 2018 Medicare Physician Fee Schedule (MPFS).
What are the meaningful proposed changes for Otolaryngology?
Percutaneous Allergy Skin Tests (CPT code 95004)
Identified through the high expenditures screen as potentially mis-valued. CMS is proposing to maintain the work RVU of 0.01, as recommended by the RUC. For the direct PE inputs, CMS is proposing to refine the equipment times for exam table and mayo stand to 79 minutes each to account for clinical 1:4 patient monitoring time. For supplies, proposing a price of 3 cents for SH101 “negative control, allergy test” and 13 cents for “positive control, allergy test”.
The AAOA worked collaboratively with the AAAAI and ACAAI to maintain the work value and mitigate the reduction in the practice expense values.
Endoscopic Sinus Surgery (ESS) and Balloon Sinus Dilation (BSD) Codes
Working collaboratively with AAOHNS and ARS, a physician survey was deployed for the Endoscopic Sinus Surgery (ESS) and Balloon Sinus Dilation (BSD) codes tagged due to the frequency with which certain combinations of the ESS codes are performed together. The ESS codes had not been reviewed since the early 1990s. As a result, the new survey data showed a lower intraservice time. These drops resulted in decreased values ranging from 7.9 to 23.6 percent. The Balloon Sinus Dilation (BSD) survey results were more consistent with previous values, having been recently surveyed in 2011.
Please see attached the report on the 2018 proposed 2018 Proposed Physician Fee Schedule – Allergy Services, Evaluation and Management, and Endoscopic Code Values – bringing forth changes and how they are expected to impact Otolaryngology, including the proposed 2018 Endoscopic Code Values Compared to 2017 Values, the 2018 proposed physician fee schedule for Allergy Services, and the 2018 proposed physician fee schedule for Evaluation and Management.
The recommended values by CMS are only agency proposals at this point. The AAOA will continue to work with AAOHNS and ARS to submit comments on these proposed values.
Please visit AAOA’s Practice Page for more resources.