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Newly published guidance from the American College of Allergy, Asthma & Immunology (ACAAI), the American Academy of Allergy, Asthma & Immunology (AAAAI) and the American Academy of Otolaryngic Allergy (AAOA) tackles a vital issue facing allergists by providing practical recommendations…
Impact OF 2019 Physician Fee Schedule on Allergy and Sinus Services
Specialty Impact
The conversion factor for 2019 will be $36.0391 and remains essentially flat. The changes in the rule are budget-neutral in the aggregate which explains why the impact for all physicians is shown as zero. The final rule shows changes in the range of minus5% to plus 4%, with allergy seeing a 1% decrease and otolaryngology seeing no change.
Changes to Supply and Equipment Prices
CMS finalized its proposal to adopt updated direct PE input prices for supplies and equipment based on a market research study undertaken for this update. However, in response to public comments including those from AAOA in coalition with the American College of Allergy, Asthma & Immunology, the Advocacy Council of the American College of Allergy, Asthma & Immunology, and the American Academy of Allergy, Asthma & Immunology, CMS improved the supply pricing for 3 antigen codes. The final supply values for these three supply codes as well as others of interest to AAOA members follow.
| Supply/Equipment Code | Description | CY 2018 Price | Proposed CY 2019 Price | Final CY 2019 Price |
| SH007 | antigen, multi (pollen, mite, mold, cat) | $6.700 | $4.780 | $8.960 |
| SH009 | antigen, venom | $20.140 | $27.360 | $30.930 |
| SH010 | antigen, venom, tri-vespid | $44.050 | $51.320 | $60.240 |
| SA106 | Balloon Sinus Surgery Kit | $2,599.86 | $2,876.22 | $2,374.33 |
Determination of PE RVUs – Balloon Sinus Surgery Kits
CMS solicited comments on whether the quantity of0.5 balloon sinus surgery kits per sinus included CPT codes 31295-31297 was typical and whether the pricing of the kits is appropriate. Based on the comments received, the agency decided not to make any changes to the balloon sinus surgery kit supply code outside of the market-based supply and equipment update as they do not believe they have sufficient information to revise the quantities or prices.
Scope Proposals for CY 2019
MS did not make any further changes to scope equipment in the CY 2019 final rule and are waiting until CY 2020 to allow them to incorporate feedback from the RUC Scope Equipment Reorganization Work groupthat will make recommendations on scope organization and pricing.
The agency did update the price of the scope video system (ES031) from $33,391 to $36,306 to reflect the addition of the LED light and miscellaneous small equipment associated with the system that is not separately priced.
