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Medicare Proposes New Rules - How Will They Affect You?

09-22-2014 Countdown

by Vlad Hurduc
September 14, 2014

Pending changes to Medicare payment rules will soon impact practitioners. Proposed updates include the deletion of biopsy codes, the revaluation of significant urology codes and the elimination of 10-/90-day global periods.

The Centers for Medicare & Medicaid Services recently proposed a number of changes to Medicare payment rules, which can be viewed in full on the CMS website (www.CMS.gov). This year’s proposal includes reimbursement changes, modifications to value-based payments, potential relative value unit (RVU) changes, under attack codes, and a change in global periods for future years, among others.

Affected entities had until September 2 to submit comments on the proposed rule. The AUA and other groups continue to prepare comments. For now, these are just proposals; the final rule will be published in late October or early November.

Targeted Misvalued Codes:

For 2015, Medicare has identified a few codes that are “misvalued,” meaning that Medicare feels the codes are valued too high. Here is a list of included CPTs significant to urology:

  1. Cystourethroscopy as a separate procedure (52000)
  2. Abdominal ultrasounds (76700, 76705)
  3. One urodynamics code (51728)
  4. Post-void residual (51798)
  5. Bladder instillation (51700)
  6. Prostate needle biopsy (55700)

Pathology-related prostate biopsy codes are also under review with the intention of deleting all three of the high-volume prostate G codes and keeping only the 10-20 G code at its current value.

Keep an eye on our monthly newsletter and we will continue to inform you as soon as changes are finalized.

Source: Urology Times.

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