2014 reimbursement newsletter may2final.docx...
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May 2014 {D0535927.DOCX / 1 }"CPT copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association." American Society of Echocardiography 2014 Coding and Reimbursement Newsletter The ASE Coding and Reimbursement Newsletter is a resource for cardiovascular ultrasound procedures provided in the facility and office settings. These newsletters, and the opportunity to submit questions to our coding consultant, are provided exclusively to members of ASE. Judy Rosenbloom, President of JR Associates, provides these services. For questions or comments, write to [email protected]. 2014 Physician Fee Schedule (PFS) Payments Medicare payments for physicians’ services (including payment for the interpretation of echocardiograms (professional component or “PC”)) and payment for physicians’ office overhead, clinical staff equipment and supplies (technical component or “TC”)) are influenced by the Sustainable Growth rate (SGR), relative value units (RVUs) and various billing and payment policies. Medicare physician payment rates are set with a formula based on economic growth known as the "sustainable growth rate" (SGR). Because spending on physician services has outpaced growth, the formula has called for cuts in reimbursement each year over the past decade. A 24% reduction in reimbursement was designated for 2014. As in previous years, to avert the cut, Congress passed a temporary solution: The Protecting Access to Medicare Act of 2014 was signed into law on April 1, 2014. The bill prevents a 24% cut in reimbursement for physicians treating Medicare patients on April 1, 2014 and replaces it with a 0.5% update (through December 31, 2014) and a 0% update from January 1 until April 1, 2015. The National Average Medicare fee schedule amounts are the product of three factors: Total RVUs x Conversion Factor (CF) = National Average Payment (See Table 1 RVU list) Relative Value Units (RVU): For each procedure/service represented by a code, three RVU components are assigned; to account for the relative resource costs used to provide a service/ procedure. o Physician work: reflects relative levels of physician time/ intensity associated with furnishing a service o Practice expense (PE): reflects practice costs (e.g., office space, supplies and equipment, and staff) o Malpractice expense (MP): represents payment for the professional liability expenses Geographic Practice Cost Indices (GPCI) account for the geographic differences in the cost of practice across the country. CMS calculates an individual GPCI for each of the RVU components. Conversion Factor (CF) is a dollar amount used to convert RVUs into a payment amount adjusted for budget neutrality (which accounts for meeting the target SGR). The CF is updated annually and is $35.8228 for 2014. Payment: (See Table 2) Echocardiography: Medicare payment for the equipment, supplies, non-physician personnel and overhead involved in the provision of echocardiography services (“Technical Component” or “TC”) in non-hospital settings increased substantially in 2014, with RVUs increasing by 23% for the TC of the most commonly performed echo services (CPT 93306- TTE with spectral and color Doppler) and an approximate 15% increase in Medicare payment for the “global” service (PC and TC combined).. The 2014 Medicare payment increase for stress echo (CPT 93351) is in the same range (23% increase for the TC and 14% increase for the global service). The increased payment for echo TC services resulted primarily from the inclusion of an “ultrasound room” in the echo allowances, similar to the ultrasound room used to compute payment for other ultrasound services. This change was made in large part in response to comments made by ASE over a period of years; however CMS is continuing to examine the issue and ASE is working with ACC to ensure that the increased rates are maintained. Vascular: Various technical adjustments have been made to the RVUs, resulting in payment decreases for some vascular procedures.
Transcript of 2014 reimbursement newsletter may2final.docx...
May 2014
{D0535927.DOCX / 1 }"CPT copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical
Association."
American Society of Echocardiography 2014 Coding and Reimbursement Newsletter
The ASE Coding and Reimbursement Newsletter is a resource for cardiovascular ultrasound procedures provided in the facility and office settings. These newsletters, and the opportunity to submit questions to our coding consultant, are provided exclusively to members of ASE. Judy Rosenbloom, President of JR Associates, provides these services. For questions or comments, write to [email protected].
2014 Physician Fee Schedule (PFS) Payments
Medicare payments for physicians’ services (including payment for the interpretation of echocardiograms (professional component or “PC”)) and payment for physicians’ office overhead, clinical staff equipment and supplies (technical component or “TC”)) are influenced by the Sustainable Growth rate (SGR), relative value units (RVUs) and various billing and payment policies.
Medicare physician payment rates are set with a formula based on economic growth known as the "sustainable growth rate" (SGR). Because spending on physician services has outpaced growth, the formula has called for cuts in reimbursement each year over the past decade. A 24% reduction in reimbursement was designated for 2014.
As in previous years, to avert the cut, Congress passed a temporary solution: The Protecting Access to Medicare Act of 2014 was signed into law on April 1, 2014. The bill prevents a 24% cut in reimbursement for physicians treating Medicare patients on April 1, 2014 and replaces it with a 0.5% update (through December 31, 2014) and a 0% update from January 1 until April 1, 2015.
The National Average Medicare fee schedule amounts are the product of three factors: Total RVUs x Conversion Factor (CF) = National Average Payment (See Table 1 RVU list)
Relative Value Units (RVU): For each procedure/service represented by a code, three RVU components are assigned; to account for the relative resource costs used to provide a service/ procedure.
o Physician work: reflects relative levels of physician time/ intensity associated with furnishing a service
o Practice expense (PE): reflects practice costs (e.g., office space, supplies and equipment, and staff)
o Malpractice expense (MP): represents payment for the professional liability expenses
Geographic Practice Cost Indices (GPCI) account for the geographic differences in the cost of practice across the country. CMS calculates an individual GPCI for each of the RVU components.
Conversion Factor (CF) is a dollar amount used to convert RVUs into a payment amount adjusted for budget neutrality (which accounts for meeting the target SGR). The CF is updated annually and is $35.8228 for 2014. Payment: (See Table 2)
Echocardiography: Medicare payment for the equipment, supplies, non-physician personnel and overhead involved in the provision of echocardiography services (“Technical Component” or “TC”) in non-hospital settings increased substantially in 2014, with RVUs increasing by 23% for the TC of the most commonly performed echo services (CPT 93306- TTE with spectral and color Doppler) and an approximate 15% increase in Medicare payment for the “global” service (PC and TC combined).. The 2014 Medicare payment increase for stress echo (CPT 93351) is in the same range (23% increase for the TC and 14% increase for the global service).
The increased payment for echo TC services resulted primarily from the inclusion of an “ultrasound room” in the echo allowances, similar to the ultrasound room used to compute payment for other ultrasound services. This change was made in large part in response to comments made by ASE over a period of years; however CMS is continuing to examine the issue and ASE is working with ACC to ensure that the increased rates are maintained.
Vascular: Various technical adjustments have been made to the RVUs, resulting in payment decreases for some vascular procedures.
{D0535927.DOCX / 1 }May 2014 ASE Coding and Reimbursement Newsletter – A Membership Benefit- www.asecho.org CPT Copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
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Table 1 – Comparison of Relative Value Units from 2013 to 2014
HCPCS/ CPT
MOD DESCRIP
2013 Work RVU
2014 Work RVU
2013 PE
RVU
2014 PE
RVU
2013 MP
RVU
2014 MP
RVU
Total 2013 RVU
Total 2014 RVU
% Change
2013-2014
ECHOCARDIOGRAPHY
TTE
93303
TTE congenital
complete 1.3 1.3 4.46 5.33 0.05 0.05 5.81 6.68 15%
TC TTE congenital
complete 0 0 3.97 4.87 0.01 0.01 3.98 4.88 23%
26 TTE congenital
complete 1.3 1.3 0.49 0.46 0.04 0.04 1.83 1.8 -2%
93304
TTE congenital fw-
up or lmtd 0.75 0.75 3.07 3.64 0.04 0.04 3.86 4.43 15%
TC TTE congenital fw-
up or lmtd 0 0 2.79 3.38 0.01 0.01 2.8 3.39 21%
26 TTE congenital fw-
up or lmtd 0.75 0.75 0.28 0.26 0.03 0.03 1.06 1.04 -2%
93306
TTE w/ Doppler
complete 1.3 1.3 4.22 5.05 0.05 0.05 5.57 6.4 15%
TC TTE w/ Doppler
complete 0 0 3.74 4.59 0.01 0.01 3.75 4.6 23%
26 TTE w/ Doppler
complete 1.3 1.3 0.48 0.46 0.04 0.04 1.82 1.8 -1%
93307
TTE w/o Doppler
complete 0.92 0.92 2.4 2.74 0.04 0.04 3.36 3.7 10%
TC TTE w/o Doppler
complete 0 0 2.05 2.41 0.01 0.01 2.06 2.42 17%
26 TTE w/o Doppler
complete 0.92 0.92 0.35 0.33 0.03 0.03 1.3 1.28 -2%
93308
TTE fw-up or lmtd 0.53 0.53 2.4 2.9 0.02 0.02 2.95 3.45 17%
TC TTE fw-up or lmtd 0 0 2.21 2.72 0.01 0.01 2.22 2.73 23%
26 TTE fw-up or lmtd 0.53 0.53 0.19 0.18 0.01 0.01 0.73 0.72 -1%
TEE
93312
TEE 2.2 2.2 6.69 7.01 0.1 0.1 8.99 9.31 4%
TC TEE 0 0 5.96 6.32 0.03 0.03 5.99 6.35 6%
26 TEE 2.2 2.2 0.73 0.69 0.07 0.07 3 2.96 -1%
93314 TEE 1.25 1.25 7.06 7.31 0.07 0.07 8.38 8.63 3%
TC TEE 0 0 6.63 6.91 0.03 0.03 6.66 6.94 4%
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HCPCS/ CPT
MOD DESCRIP
2013 Work RVU
2014 Work RVU
2013 PE
RVU
2014 PE
RVU
2013 MP
RVU
2014 MP
RVU
Total 2013 RVU
Total 2014 RVU
% Change
2013-2014
26 TEE 1.25 1.25 0.43 0.4 0.04 0.04 1.72 1.69 -2%
93315
TEE 0 0 0 0 0 0 0 0 0
TC TEE 0 0 0 0 0 0 0 0 0
26 TEE 2.78 2.78 0.98 0.92 0.23 0.22 3.99 3.92 -2%
93316
TEE 0.95 0.95 0.21 0.19 0.07 0.07 1.23 1.21 -2%
93317
TEE 0 0 0 0 0 0 0 0 0
TC TEE 0 0 0 0 0 0 0 0 0
26 TEE 1.83 1.83 0.63 0.61 0.23 0.22 2.69 2.66 -1%
93318
TEE intraop 0 0 0 0 0 0 0 0 0
TC TEE intraop 0 0 0 0 0 0 0 0 0
26 TEE intraop 2.2 2.2 0.71 0.68 0.31 0.3 3.22 3.18 -1%
Doppler
93320
Doppler echo exam
heart 0.38 0.38 0.92 1.13 0.02 0.02 1.32 1.53 16%
TC Doppler echo exam
heart 0 0 0.78 1 0.01 0.01 0.79 1.01 28%
26 Doppler echo exam
heart 0.38 0.38 0.14 0.13 0.01 0.01 0.53 0.52 -2%
93321
Doppler echo exam
heart 0.15 0.15 0.53 0.7 0.02 0.02 0.7 0.87 24%
TC Doppler echo exam
heart 0 0 0.48 0.65 0.01 0.01 0.49 0.66 35%
26 Doppler echo exam
heart 0.15 0.15 0.05 0.05 0.01 0.01 0.21 0.21 0%
93325
Doppler color flow
add-on 0.07 0.07 0.5 0.64 0.02 0.02 0.59 0.73 24%
TC Doppler color flow
add-on 0 0 0.47 0.62 0.01 0.01 0.48 0.63 31%
26 Doppler color flow
add-on 0.07 0.07 0.03 0.02 0.01 0.01 0.11 0.1 -9%
Stress Echo
93350
Stress TTE only 1.46 1.46 4.37 5.24 0.06 0.06 5.89 6.76 15%
TC Stress TTE only 0 0 3.83 4.73 0.01 0.01 3.84 4.74 23%
26 Stress TTE only 1.46 1.46 0.54 0.51 0.05 0.05 2.05 2.02 -1%
93351
Stress TTE complete 1.75 1.75 5.06 6.03 0.08 0.08 6.89 7.86 14%
TC Stress TTE complete 0 0 4.41 5.42 0.03 0.03 4.44 5.45 23%
{D0535927.DOCX / 1 }May 2014 ASE Coding and Reimbursement Newsletter – A Membership Benefit- www.asecho.org CPT Copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
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HCPCS/ CPT
MOD DESCRIP
2013 Work RVU
2014 Work RVU
2013 PE
RVU
2014 PE
RVU
2013 MP
RVU
2014 MP
RVU
Total 2013 RVU
Total 2014 RVU
% Change
2013-2014
26 Stress TTE complete 1.75 1.75 0.65 0.61 0.05 0.05 2.45 2.41 -2%
93352
Admin ECG contrast agent
0.19 0.19 0.82 0.74 0.01 0.01 1.02 0.94 -8%
Fetal Echo
76825
Echo exam of fetal
heart 1.67 1.67 4.8 6.01 0.05 0.05 6.52 7.73 19%
TC Echo exam of fetal
heart 0 0 4.13 5.38 0.01 0.01 4.14 5.39 30%
26 Echo exam of fetal
heart 1.67 1.67 0.67 0.63 0.04 0.04 2.38 2.34 -2%
76826
Echo exam of fetal
heart 0.83 0.83 3.06 3.76 0.04 0.04 3.93 4.63 18%
TC Echo exam of fetal
heart 0 0 2.73 3.45 0.01 0.01 2.74 3.46 26%
26 Echo exam of fetal
heart 0.83 0.83 0.33 0.31 0.03 0.03 1.19 1.17 -2%
76827
Echo exam of fetal
heart 0.58 0.58 1.18 1.53 0.02 0.02 1.78 2.13 20%
TC Echo exam of fetal
heart 0 0 0.95 1.31 0.01 0.01 0.96 1.32 38%
26 Echo exam of fetal
heart 0.58 0.58 0.23 0.22 0.01 0.01 0.82 0.81 -1%
76828
Echo exam of fetal
heart 0.56 0.56 0.74 0.91 0.02 0.02 1.32 1.49 13%
TC Echo exam of fetal
heart 0 0 0.51 0.69 0.01 0.01 0.52 0.7 35%
26 Echo exam of fetal
heart 0.56 0.56 0.23 0.22 0.01 0.01 0.8 0.79 -1%
3-D
76376
3D render w/o post
process 0.2 0.2 1.55 0.59 0.02 0.02 1.77 0.81 -54%
TC 3D render w/o post
process 0 0 1.48 0.52 0.01 0.01 1.49 0.53 -64%
26 3D render w/o post
process 0.2 0.2 0.07 0.07 0.01 0.01 0.28 0.28 0%
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HCPCS/ CPT
MOD DESCRIP
2013 Work RVU
2014 Work RVU
2013 PE
RVU
2014 PE
RVU
2013 MP
RVU
2014 MP
RVU
Total 2013 RVU
Total 2014 RVU
% Change
2013-2014
76377
3D rendering w/ post
process 0.79 0.79 1.59 1.51 0.05 0.05 2.43 2.35 -3%
TC 3D rendering w/ post
process 0 0 1.3 1.22 0.01 0.01 1.31 1.23 -6%
26 3D rendering w/ post
process 0.79 0.79 0.29 0.29 0.04 0.04 1.12 1.12 0%
VASCULAR
AAA Screening
G0389
Ultrasound exam
AAA screen 0.58 0.58 2.64 1.23 0.04 0.04 3.26 1.85 -43%
TC Ultrasound exam
AAA screen 0 0 2.43 1.02 0.01 0.01 2.44 1.03 -58%
26 Ultrasound exam
AAA screen 0.58 0.58 0.21 0.21 0.03 0.03 0.82 0.82 0%
Carotid Duplex
93880
Extracranial study 0.6 0.6 6.53 4.71 0.05 0.05 7.18 5.36 -25%
TC Extracranial study 0 0 6.32 4.5 0.01 0.01 6.33 4.51 -29%
26 Extracranial study 0.6 0.6 0.21 0.21 0.04 0.04 0.85 0.85 0%
93882
Extracranial study 0.4 0.4 4.71 3.01 0.06 0.06 5.17 3.47 -33%
TC Extracranial study 0 0 4.58 2.88 0.01 0.01 4.59 2.89 -37%
26 Extracranial study 0.4 0.4 0.13 0.13 0.05 0.05 0.58 0.58 0%
TCD
93886
Intracranial study 0.94 0.94 10.2 9.1 0.05 0.05 11.19 10.09 -10%
TC Intracranial study 0 0 9.79 8.71 0.01 0.01 9.8 8.72 -11%
26 Intracranial study 0.94 0.94 0.41 0.39 0.04 0.04 1.39 1.37 -1%
93888
Intracranial study 0.62 0.62 5.83 5.23 0.05 0.05 6.5 5.9 -9%
TC Intracranial study 0 0 5.58 5 0.01 0.01 5.59 5.01 -10%
26 Intracranial study 0.62 0.62 0.25 0.23 0.04 0.04 0.91 0.89 -2%
93890
Tcd vasoreactivity study
1 1 7.75 7.08 0.05 0.05 8.8 8.13 -8%
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HCPCS/ CPT
MOD DESCRIP
2013 Work RVU
2014 Work RVU
2013 PE
RVU
2014 PE
RVU
2013 MP
RVU
2014 MP
RVU
Total 2013 RVU
Total 2014 RVU
% Change
2013-2014
TC Tcd vasoreactivity
study 0 0 7.34 6.68 0.01 0.01 7.35 6.69 -9%
26 Tcd vasoreactivity
study 1 1 0.41 0.4 0.04 0.04 1.45 1.44 -1%
93892
Tcd emboli detect
w/o inj 1.15 1.15 8.73 8.26 0.06 0.06 9.94 9.47 -5%
TC Tcd emboli detect
w/o inj 0 0 8.25 7.79 0.01 0.01 8.26 7.8 -6%
26 Tcd emboli detect
w/o inj 1.15 1.15 0.48 0.47 0.05 0.05 1.68 1.67 -1%
93893
Tcd emboli detect
w/inj 1.15 1.15 9.4 8.57 0.06 0.06 10.61 9.78 -8%
TC Tcd emboli detect
w/inj 0 0 8.9 8.09 0.01 0.01 8.91 8.1 -9%
26 Tcd emboli detect
w/inj 1.15 1.15 0.5 0.48 0.05 0.05 1.7 1.68 -1%
Peripheral Arterial
93922
Upr/l xtremity art 2
levels 0.25 0.25 2.5 2.22 0.02 0.02 2.77 2.49 -10%
TC Upr/l xtremity art 2
levels 0 0 2.41 2.14 0.01 0.01 2.42 2.15 -11%
26 Upr/l xtremity art 2
levels 0.25 0.25 0.09 0.08 0.01 0.01 0.35 0.34 -3%
93923
Upr/lxtr art stdy 3+
lvls 0.45 0.45 3.8 3.41 0.05 0.05 4.3 3.91 -9%
TC Upr/lxtr art stdy 3+
lvls 0 0 3.65 3.27 0.01 0.01 3.66 3.28 -10%
26 Upr/lxtr art stdy 3+
lvls 0.45 0.45 0.15 0.14 0.04 0.04 0.64 0.63 -2%
93924
Lwr xtr vasc stdy bilat 0.5 0.5 4.84 4.36 0.05 0.05 5.39 4.91 -9%
TC Lwr xtr vasc stdy bilat 0 0 4.67 4.2 0.01 0.01 4.68 4.21 -10%
26 Lwr xtr vasc stdy bilat 0.5 0.5 0.17 0.16 0.04 0.04 0.71 0.7 -1%
93925
Lower extremity
study 0.8 0.8 6.66 6.03 0.09 0.09 7.55 6.92 -8%
TC Lower extremity
study 0 0 6.38 5.76 0.03 0.03 6.41 5.79 -10%
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7
HCPCS/ CPT
MOD DESCRIP
2013 Work RVU
2014 Work RVU
2013 PE
RVU
2014 PE
RVU
2013 MP
RVU
2014 MP
RVU
Total 2013 RVU
Total 2014 RVU
% Change
2013-2014
26 Lower extremity
study 0.8 0.8 0.28 0.27 0.06 0.06 1.14 1.13 -1%
93926
Lower extremity
study 0.5 0.5 3.77 3.4 0.07 0.07 4.34 3.97 -9%
TC Lower extremity
study 0 0 3.61 3.25 0.01 0.01 3.62 3.26 -10%
26 Lower extremity
study 0.5 0.5 0.16 0.15 0.06 0.06 0.72 0.71 -1%
93930
Upper extremity
study 0.46 0.46 6.7 5.95 0.05 0.05 7.21 6.46 -10%
TC Upper extremity
study 0 0 6.54 5.8 0.01 0.01 6.55 5.81 -11%
26 Upper extremity
study 0.46 0.46 0.16 0.15 0.04 0.04 0.66 0.65 -2%
93931
Upper extremity
study 0.31 0.31 4.48 4.07 0.04 0.04 4.83 4.42 -8%
TC Upper extremity
study 0 0 4.38 3.97 0.01 0.01 4.39 3.98 -9%
26 Upper extremity
study 0.31 0.31 0.1 0.1 0.03 0.03 0.44 0.44 0%
Venous Extremity
93965
Extremity study 0.35 0.35 3.31 3.01 0.04 0.04 3.7 3.4 -8%
TC Extremity study 0 0 3.19 2.89 0.01 0.01 3.2 2.9 -9%
26 Extremity study 0.35 0.35 0.12 0.12 0.03 0.03 0.5 0.5 0%
93970
Extremity study 0.7 0.7 4.91 4.49 0.08 0.08 5.69 5.27 -7%
TC Extremity study 0 0 4.67 4.26 0.01 0.01 4.68 4.27 -9%
26 Extremity study 0.7 0.7 0.24 0.23 0.07 0.07 1.01 1 -1%
93971
Extremity study 0.45 0.45 2.94 2.7 0.05 0.05 3.44 3.2 -7%
TC Extremity study 0 0 2.79 2.55 0.01 0.01 2.8 2.56 -9%
26 Extremity study 0.45 0.45 0.15 0.15 0.04 0.04 0.64 0.64 0%
Abdominal Duplex
93975
Vascular study 1.8 1.8 8.89 8.14 0.17 0.16 10.86 10.1 -7%
TC Vascular study 0 0 8.26 7.53 0.03 0.03 8.29 7.56 -9%
{D0535927.DOCX / 1 }May 2014 ASE Coding and Reimbursement Newsletter – A Membership Benefit- www.asecho.org CPT Copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
8
HCPCS/ CPT
MOD DESCRIP
2013 Work RVU
2014 Work RVU
2013 PE
RVU
2014 PE
RVU
2013 MP
RVU
2014 MP
RVU
Total 2013 RVU
Total 2014 RVU
% Change
2013-2014
26 Vascular study 1.8 1.8 0.63 0.61 0.14 0.13 2.57 2.54 -1%
93976
Vascular study 1.21 1.21 5 4.66 0.09 0.09 6.3 5.96 -5%
TC Vascular study 0 0 4.57 4.23 0.01 0.01 4.58 4.24 -7%
26 Vascular study 1.21 1.21 0.43 0.43 0.08 0.08 1.72 1.72 0%
93978
Vascular study 0.65 0.65 6.24 5.6 0.08 0.08 6.97 6.33 -9%
TC Vascular study 0 0 6.02 5.4 0.01 0.01 6.03 5.41 -10%
26 Vascular study 0.65 0.65 0.22 0.2 0.07 0.07 0.94 0.92 -2%
93979
Vascular study 0.44 0.44 4.33 3.89 0.05 0.05 4.82 4.38 -9%
TC Vascular study 0 0 4.19 3.76 0.01 0.01 4.2 3.77 -10%
26 Vascular study 0.44 0.44 0.14 0.13 0.04 0.04 0.62 0.61 -2%
Hemodialysis Duplex
93990
Doppler flow testing 0.25 0.25 5.87 5.17 0.05 0.05 6.17 5.47 -11%
TC Doppler flow testing 0 0 5.8 5.1 0.01 0.01 5.81 5.11 -12%
26 Doppler flow testing 0.25 0.25 0.07 0.07 0.04 0.04 0.36 0.36 0%
{D0535927.DOCX / 1 }May 2014 ASE Coding and Reimbursement Newsletter – A Membership Benefit- www.asecho.org CPT Copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
9
Table 2 – National Average Medicare PFS Payments: Echocardiography and Vascular Ultrasound
HCPCS/ CPT
MOD DESCRIP 2013
Payment 2014
Payment $ Change 2013-2014
% Change 2013-2014
ECHOCARDIOGRAPHY
TTE
93303
Transthoracic echocardiography for congenital cardiac anomalies; complete
$198 $239 $42 21%
TC $135 $175 $39 29%
26 $62 $64 $2 4%
93304
Transthoracic echocardiography for congenital cardiac anomalies;follow-up or limited study
$131 $159 $27 21%
TC $95 $121 $26 27%
26 $36 $37 $1 3%
93306
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography
$190 $229 $40 21%
TC $128 $165 $37 29%
26 $62 $64 $3 4%
93307
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography
$114 $133 $18 16%
TC $70 $87 $17 24%
26 $44 $46 $2 4%
93308
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study
$100 $124 $23 23%
TC $76 $98 $22 29%
26 $25 $26 $1 4%
TEE
93312
Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report
$306 $334 $28 9%
TC $204 $227 $24 12%
26 $102 $106 $4 4%
93313
Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); placement of transesophageal probe only
$41 $43 $1 4%
93314
Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); image acquisition, interpretation and report only
$285 $309 $24 8%
TC $227 $249 $22 10%
26 $59 $61 $2 3%
93315*
Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report
$0 $0 $0 $0
TC $0 $0 $0 $0
26 $136 $140 $5 3%
93316
Transesophageal Echocardiography (TEE) for congenital cardiac anomalies; placement of transesophageal probe only
$42 $43 $1 4%
93317*
Transesophageal Echocardiography (TEE) for congenital cardiac anomalies; image acquisition, interpretation and report only.
$0 $0 $0 $0
TC $0 $0 $0 $0
26 $92 $95 $4 4%
93318*
Echocardiography, transesophageal (tee) for monitoring purposes, including probe placement, real time 2-
$0 $0 $0 $0
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10
HCPCS/ CPT
MOD DESCRIP 2013
Payment 2014
Payment $ Change 2013-2014
% Change 2013-2014
TC dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis
$0 $0 $0 $0
26 $110 $114 $4 4%
Doppler
93320
Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); complete.
$45 $55 $10 22%
TC $27 $36 $9 35%
26 $18 $19 $1 3%
93321
Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); follow-up or limited study.
$24 $31 $7 31%
TC $17 $24 $7 42%
26 $7 $8 $0 5%
93325
Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiographic imaging)
$20 $26 $6 30%
TC $16 $23 $6 38%
26 $4 $4 $0 -4%
Stress Echo
93350
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation
$200 $242 $42 21%
TC $131 $170 $39 30%
26 $70 $72 $3 4%
93351
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation
$234 $282 $47 20%
TC $151 $195 $44 29%
26 $83 $86 $3 4%
93352
Use of echocardiographic contrast agent during stress echocardiography (List separately in addition to code for primary procedure)
$35 $34 -$1 -3%
Stress Test
93015
Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report
$80 $76 -$4 -5%
93016
Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; physician supervision only, without interpretation and report.
$21 $22 $1 4%
93017
Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report.
$44 $39 -$5 -11%
93018
Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress;interpretation and report only
$14 $15 $0 3%
Fetal Echo
76825 Echocardiography, fetal, cardiovascular system, real time
with image documentation (2D) with or without M-mode recording; complete
$222 $277 $55 25%
TC $141 $193 $52 37%
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11
HCPCS/ CPT
MOD DESCRIP 2013
Payment 2014
Payment $ Change 2013-2014
% Change 2013-2014
26 $81 $84 $3 4%
76826
Echocardiography, fetal, cardiovascular system, real time with image documentation (2D) with or without M-mode recording; follow up or repeat study
$134 $166 $32 24%
TC $93 $124 $31 33%
26 $40 $42 $1 4%
76827
Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete
$61 $76 $16 26%
TC $33 $47 $15 45%
26 $28 $29 $1 4%
76828
Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study
$45 $53 $8 19%
TC $18 $25 $7 42%
26 $27 $28 $1 4%
3-D
76376
3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring image post-processing on an independent workstation
$60 $29 -$31 -52%
TC $51 $19 -$32 -63%
26 $10 $10 $1 5%
76377
3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; requiring image post-processing on an independent workstation
$83 $84 $2 2%
TC $45 $44 -$1 -1%
26 $38 $40 $2 5%
Contrast Agents
Q9955
Perflexane Lipid microspheres, per ml Average Sales Price
Average Sales Price
Average Sales Price
Average Sales Price
Q9956
Octafluoropropane microspheres, per ml Average Sales Price
Average Sales Price
Average Sales Price
Average Sales Price
Q9957
Perflutren lipid microspheres, per ml Average Sales Price
Average Sales Price
Average Sales Price
Average Sales Price
VASCULAR
AAA Screening
G0389
Ultrasound B-scan and/or real time with image documentation; for abdominal aortic aneurysm (AAA) screening
$111 $66 -$45 -40%
TC $83 $37 -$46 -56%
26 $28 $29 $1 5%
Carotid
93880
Duplex scan of extracranial arteries; complete bilateral study
$244 $192 -$52 -21%
TC $215 $162 -$54 -25%
26 $29 $30 $2 5%
93882
Duplex scan of extracranial arteries; unilateral or limited study
$176 $124 -$52 -29%
TC $156 $104 -$53 -34%
26 $20 $21 $1 5%
TCD
Transcranial Doppler study of the intracranial arteries; complete study
$381 $361 -$19 -5%
93886 TC $333 $312 -$21 -6%
26 $47 $49 $2 4%
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12
HCPCS/ CPT
MOD DESCRIP 2013
Payment 2014
Payment $ Change 2013-2014
% Change 2013-2014
93888
Transcranial Doppler study of the intracranial arteries; limited study
$221 $211 -$10 -4%
TC $190 $179 -$11 -6%
26 $31 $32 $1 3%
93890
Transcranial Doppler study of the intracranial arteries; vasoreactivity study
$299 $291 -$8 -3%
TC $250 $240 -$10 -4%
26 $49 $52 $2 5%
93892
Transcranial Doppler study of the intracranial arteries; emboli detection without intravenous microbubble injection
$338 $339 $1 0%
TC $281 $279 -$2 -1%
26 $57 $60 $3 5%
93893
Transcranial doppler study of the intracranial arteries; emboli detection with intravenous microbubble injection
$361 $350 -$11 -3%
TC $303 $290 -$13 -4%
26 $58 $60 $2 4%
Peripheral Arterial
93922
Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with transcutaneous oxygen tension measurements at 1-2 levels)
$94 $89 -$5 -5%
TC $82 $77 -$5 -6%
26 $12 $12 $0 2%
93923
Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional doppler waveform recording and analysis, at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental volume plethysmography at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental transcutaneous oxygen tension measurements at 3 or more level(s), or single level study with provocative functional maneuvers (eg, measurements with postural provocative tests, or measurements with reactive hyperemia)
$146 $140 -$6 -4%
TC $125 $117 -$7 -6%
26 $22 $23 $1 4%
93924
Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, (ie, bidirectional doppler waveform or volume plethysmography recording and analysis at rest with ankle/brachial indices immediately after and at timed intervals following performance of a standardized protocol on a motorized treadmill plus recording of time of onset of claudication or other symptoms, maximal walking time, and time to recovery) complete bilateral study
$183 $176 -$7 -4%
TC $159 $151 -$8 -5%
26 $24 $25 $1 4%
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study
$257 $248 -$9 -3%
93925 TC $218 $207 -$11 -5%
26 $39 $40 $2 4%
93926
Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study
$148 $142 -$5 -4%
TC $123 $117 -$6 -5%
26 $25 $25 $1 4%
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13
HCPCS/ CPT
MOD DESCRIP 2013
Payment 2014
Payment $ Change 2013-2014
% Change 2013-2014
93930
Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study
$245 $231 -$14 -6%
TC $223 $208 -$15 -7%
26 $22 $23 $1 4%
93931
Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study
$164 $158 -$6 -4%
TC $149 $143 -$7 -5%
26 $15 $16 $1 5%
Venous Extremity
93965
Noninvasive physiologic studies of extremity veins, complete bilateral study (eg, doppler waveform analysis with responses to compression and other maneuvers, phleborheography, impedance plethysmography)
$126 $122 -$4 -3%
TC $109 $104 -$5 -5%
26 $17 $18 $1 5%
93970
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study
$194 $189 -$5 -2%
TC $159 $153 -$6 -4%
26 $34 $36 $1 4%
93971
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study
$117 $115 -$2 -2%
TC $95 $92 -$4 -4%
26 $22 $23 $1 5%
Abdominal Duplex
93975
Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study
$369 $362 -$8 -2%
TC $282 $271 -$11 -4%
26 $87 $91 $4 4%
93976
Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study
$214 $214 -$1 0%
TC $156 $152 -$4 -3%
26 $59 $62 $3 5%
93978
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study
$237 $227 -$10 -4%
TC $205 $194 -$11 -6%
26 $32 $33 $1 3%
93979
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study
$164 $157 -$7 -4%
TC $143 $135 -$8 -5%
26 $21 $22 $1 4%
Hemodialysis Access Duplex
93990
Duplex scan of hemodialysis access (including arterial inflow, body of access and venous outflow)
$210 $196 -$14 -7%
TC $198 $183 -$15 -7%
26 $12 $13 $1 5%
* Modifier 26 indicates the physician professional component (for billing purposes). Imaging procedures require reporting of this modifier when the physician’s professional services are performed outside of the physician office setting (e.g., hospital). When the procedure is provided in the non-facility setting (i.e. physician office), the CPT code is reported with no modifier appended (global billing: professional component [-26] +technical component [TC]). Certain procedures (e.g., stress tests, TEE probe insertion) are not designated with TC/PC modifiers. **DRA cap applies. Refer to OPPS for payment reference
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14
2014 Hospital Outpatient Procedure Payments
Hospitals are reimbursed by Medicare for outpatient procedures and services under the Outpatient Prospective Payment System (OPPS), which utilizes the Ambulatory Payment Classification (APC) system. Services are reported with CPT codes and/or HCPCS C-codes; each payable code is designated to an APC group. APC groups contain services that are clinically similar and generally require similar resources. Each APC is assigned a payment rate. When multiple codes are reported at the same encounter, the hospital may be paid for more than one APC. Payments to hospitals cover resources such as equipment, supplies, and staff. Payment for the APC does not include physician reimbursement.
Medicare payment to hospital outpatient departments for echo services under the APC system increased by 6-18% in 2014, with increases for most hospital outpatient echo services in the 9% range. Medicare payment for contrast-enhanced procedures also increased (from 13-15%), and Medicare payment for many vascular procedures increased substantially (in the range of 21-35%).
Table 3 - 2013/2014 Comparison: Echocardiography and Vascular Ultrasound Hospital Outpatient Payments
HCPCS/ 2013 APC
2014 APC
DESCRIPTION 2013
Payment 2014
Payment $ change
% change CPT
ECHOCARDIOGRAPHY
TTE
93303 270 270 Transthoracic echocardiography for congenital cardiac anomalies; complete $559 $594 $36 6%
93304 269 269 Transthoracic echocardiography for congenital cardiac anomalies; f/u or limited $390 $427 $37 9%
93306 269 269
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography
$390 $427 $37 9%
93307* 269 269
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography
$390 $427 $37 9%
93308 697 697
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study
$213 $251 $38 18%
TEE
93312 270 270
Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report
$559 $594 $36 6%
93313 269 269
Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); placement of transesophageal probe only
$390 $427 $37 9%
93314** -- --
Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); image acquisition, interpretation and report only
N/A N/A N/A N/A
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15
HCPCS/ 2013 APC
2014 APC
DESCRIPTION 2013
Payment 2014
Payment $ change
% change CPT
93315 269 269
Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report
$390 $427 $37 9%
93316 270 270
Transesophageal Echocardiography (TEE) for congenital cardiac anomalies; placement of transesophageal probe only
$559 $594 $36 6%
93317** --- ---
Transesophageal Echocardiography (TEE) for congenital cardiac anomalies; image acquisition, interpretation and report only.
N/A N/A N/A N/A
93318 270 270
Echocardiography, transesophageal (tee) for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis
$559 $594 $36 6%
Doppler
93320** --- ---
Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); complete.
N/A N/A N/A N/A
93321** --- ---
Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); follow-up or limited study.
N/A N/A N/A N/A
93325** --- ---
Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiographic imaging)
N/A N/A N/A N/A
Stress Echo
93350 269 269
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation
$390 $427 $37 9%
93351 270 270
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation
$559 $594 $36 6%
93352+ --- ---
Use of echocardiographic contrast agent during stress echocardiography (List separately in addition to code for primary procedure)
N/A N/A N/A N/A
Stress Test
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16
HCPCS/ 2013 APC
2014 APC
DESCRIPTION 2013
Payment 2014
Payment $ change
% change CPT
93015++
--- ---
Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report
N/A N/A N/A N/A
93016++
--- ---
Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; physician supervision only, without interpretation and report.
N/A N/A N/A N/A
93017++
100 100
Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report.
$177 $244 $67 38%
93018 --- ---
Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress;interpretation and report only
N/A N/A N/A N/A
Fetal Echo
76825 697 697
Echocardiography, fetal, cardiovascular system, real time with image documentation (2D) with or without M-mode recording; complete
$213 $251 $38 18%
76826 697 697
Echocardiography, fetal, cardiovascular system, real time with image documentation (2D) with or without M-mode recording; follow up or repeat study
$213 $251 $38 18%
76827 265 265
Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete
$65 $90 $25 39%
76828 265 265
Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study
$65 $90 $25 39%
3-D
76376 --- ---
3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring image post-processing on an independent workstation
N/A N/A N/A N/A
76377 --- ---
3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; requiring image post-processing on an independent workstation
N/A N/A N/A N/A
Echocardiography With Contrast
C8921 178 178
Transthoracic Echocardiogram with contrast for congenital cardiac anomalies; complete $578 $654 $76 13%
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17
HCPCS/ 2013 APC
2014 APC
DESCRIPTION 2013
Payment 2014
Payment $ change
% change CPT
C8922 177 177
Transthoracic Echocardiogram with contrast for congenital cardiac anomalies; follow-up or ltd study
$434 $501 $67 15%
C8923 177 177
Transthoracic Echocardiogram with contrast, real-time with image documentation (2D) with or without M-Mode recording; complete $434 $501 $67 15%
C8924 177 177
Transthoracic Echocardiogram with contrast, real-time with image documentation (2D) with or without M-Mode recording; follow-up or limited study
$434 $501 $67 15%
C8925 178 178
Transesophageal Echocardiogram (TEE) with contrast, real time with image documentation (2D) with or without M-Mode recording; including probe placement, image acquisition, interpretation and report
$578 $654 $76 13%
C8926 178 178
Transesophageal Echocardiogram (TEE) with contrast for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report
$578 $654 $76 13%
C8927 177 177
Transesophageal Echocardiogram (TEE) with contrast for monitoring purposes; including probe placement, real time 2D image acquisition and interpretation leading to continuous assessment of cardiac pumping function and to therapeutic measure on an immediate time basis
$434 $501 $67 15%
C8928 178 178
Transthoracic Echocardiogram (TTE) with contrast, real time image documentation (2D) with or without M-Mode recording; during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report
$578 $654 $76 13%
C8929 178 178
Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes m-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography
$578 $654 $76 13%
C8930 178 178
Transthoracic echocardiography, with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with physician supervision
$578 $654 $76 13%
Contrast Agents
Q9955 --- --- Perflexane Lipid microspheres, per ml N/A N/A N/A N/A
Q9956 --- --- Octafluoropropane microspheres, per ml N/A N/A N/A N/A
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18
HCPCS/ 2013 APC
2014 APC
DESCRIPTION 2013
Payment 2014
Payment $ change
% change CPT
Q9957 --- --- Perflutren lipid microspheres, per ml N/A N/A N/A N/A
VASCULAR
AAA Screening
G0389 266 265 Ultrasound B-scan and/or real time with image documentation; for abdominal aortic aneurysm (AAA) screening
$99 $90 -$9 -9%
Carotid
93880 267 267 Duplex scan of extracranial arteries; complete
bilateral study $155 $191 $36 23%
93882 267 267 Duplex scan of extracranial arteries; unilateral or limited study
$155 $191 $36 23%
TCD
93886 267 267 Transcranial Doppler study of the intracranial arteries; complete study
$155 $191 $36 23%
93888 265 266 Transcranial Doppler study of the intracranial arteries; limited study
$65 $135 $70 108%
93890 266 266 Transcranial Doppler study of the intracranial arteries; vasoreactivity study
$99 $135 $35 35%
93892 266 266 Transcranial Doppler study of the intracranial arteries; emboli detection without intravenous microbubble injection
$99 $135 $35 35%
93893 266 266 Transcranial doppler study of the intracranial arteries; emboli detection with intravenous microbubble injection
$99 $135 $35 35%
Peripheral Arterial
93922 97 97
Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with transcutaneous oxygen tension measurements at 1-2 levels)
$67 $70 $4 6%
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19
HCPCS/ 2013 APC
2014 APC
DESCRIPTION 2013
Payment 2014
Payment $ change
% change CPT
93923 96 96
Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional doppler waveform recording and analysis, at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental volume plethysmography at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental transcutaneous oxygen tension measurements at 3 or more level(s), or single level study with provocative functional maneuvers (eg, measurements with postural provocative tests, or measurements with reactive hyperemia)
$109 $131 $22 21%
93924 96 96
Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, (ie, bidirectional doppler waveform or volume plethysmography recording and analysis at rest with ankle/brachial indices immediately after and at timed intervals following performance of a standardized protocol on a motorized treadmill plus recording of time of onset of claudication or other symptoms, maximal walking time, and time to recovery) complete bilateral study
$109 $131 $22 21%
93925 267 267 Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study
$155 $191 $36 23%
93926 266 266 Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study
$99 $135 $35 35%
93930 267 267 Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study
$155 $191 $36 23%
93931 266 266 Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study
$99 $135 $35 35%
Venous Extremity
93965 96 96
Noninvasive physiologic studies of extremity veins, complete bilateral study (eg, doppler waveform analysis with responses to compression and other maneuvers, phleborheography, impedance plethysmography)
$109 $131 $22 21%
93970 267 267 Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study
$155 $191 $36 23%
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20
HCPCS/ 2013 APC
2014 APC
DESCRIPTION 2013
Payment 2014
Payment $ change
% change CPT
93971 266 266 Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study
$99 $135 $35 35%
Abdominal Duplex
93975 267 267 Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study
$155 $191 $36 23%
93976 267 267 Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study
$155 $191 $36 23%
93978 267 267 Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study
$155 $191 $36 23%
93979 266 266 Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study
$99 $135 $35 35%
Hemodialysis Duplex
93990 266 266 Duplex scan of hemodialysis access (including arterial inflow, body of access and venous outflow)
$99 $135 $35 35%
** 76376, 76377, 93314, 93317, 93320, 93321, 93325, Q9955, Q9956 and Q9957 have status code N - Packaged into an APC code.
+ Status code M - Items and Services Not Billable to the Fiscal Intermediary/MAC
++ Status code B - Codes Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill
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Multiple Procedure Payment Reduction: Technical Component of Diagnostic Cardiovascular Procedures
Physician/Office Payments
Under the Medicare Physician Fee Schedule, the Multiple Procedure Payment Reduction (MPPR) on diagnostic cardiovascular procedures applies when multiple services are furnished to the same patient on the same day. The MPPRs apply to technical component only (TC) services, and to the TC of global services for those procedures assigned a status indicator of “6.” Echocardiography and vascular ultrasound procedures are designated as status indicator “6” and are eligible for this discount.
Full payment is made for the TC service with the highest payment under the Medicare Physician Fee Schedule. Payment is made at 75% for subsequent TC services furnished by the same physician (or by multiple physicians in the same group practice) to the same patient on the same day.
Example: CPT 93306 (TTE) and 78452 (SPECT) are Status Indicator 6 on the MPFS.
Code 78452 Code 93306 Total payment Payment Calculation
PC $ 80 $ 64 $ 144 no reduction
TC $ 407 $ 165 $ 531 $407 + (.75x$165)
Global $ 486 $ 190 $ 674 $144 +$407+(.75x$165)
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7848.pdf
The MPPRs do not apply to professional component (PC) services.
This Medicare policy does not apply to hospital outpatient services.
Note: some insurance companies may adopt or plan to adopt a similar type of policy for their non-Medicare healthplans. In the May bulletin, UnitedHealthcare announced their intent to initiate a policy by Q3 2014.
Frequently Asked Coding Questions (FAQ)
1. Is there a limited TEE code? There is no "limited" code for TEE. The TEE codes were not established based on the distinction of complete or limited, and the Introductory CPT language does not specify what is considered a complete or limited for these procedures. There is no CPT guidance as to what anatomy is included in a TEE exam.
2. Does a bicuspid aortic valve finding on TTE qualify for congenital TTE? The CPT manual is not specific, but the August 2013 CPT Assistant does state: congenital heart disease, which includes defects such as atrial and ventricular septal defects, patent ductus arteriosis, Tetralogy of Fallot, transposition of the great arteries, single ventricle, and congenital defects of the cardiac valves.
3. What modifiers are applicable to echocardiography? Modifiers consist of two alphanumeric characters. Because modifiers may affect payment, they must be used correctly or claims may be denied and an audit may be initiated by a payer. Documentation in the medical record or interpretation report must support the use of a modifier. The AMA CPT codebook defines modifier usage. In some cases, CMS and other payers may establish varying guidelines different from the AMA. A complete list of modifiers can be found on the inside cover page of the AMA codebook. Note, there are separate lists for hospital and physician approved modifiers.
Modifiers to Report Technical and Professional Components: These modifiers are used with diagnostic testing codes, as they have two components: technical and professional. For payment purposes under the Medicare Part B Physician Fee Schedule (PFS) , two modifiers (TC and 26) are used to describe the circumstances when diagnostic testing services are reported separately by the physician and the outpatient setting that is covered under the Medicare PFS (i.e. imaging center and office). The acquisition of the image is the technical component, and the professional component is the physician interpretation of the exam.
-TC Technical component: The technical component provided in ambulatory settings such as doctors offices and IDTFs is reported by adding modifier TC to the CPT code. The TC modifier is reported by the entity that only provides the technical service. Institutions such as hospitals do not append the TC modifier. The use of this modifier affects payment.
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-26 Professional Component: The physician service only is reported separately by adding modifier -26 to the CPT code. The use of this modifier affects payment.
No modifier: When both components are furnished by one provider, Medicare makes a single global payment that is equal to the sum of the payment for the components. No modifier is necessary. Note that some codes such as stress test codes (93015-93018) and stress echocardiography contrast administration (93352) are designated as global codes and are never reported with -26 or TC modifiers.
The following codes may be reported with these modifiers: 93312-93314,93315,93317,93318, 93320, 93321, 93325, 93350, 93351
-22 Increased Procedural Services: This modifier is used to identify that the work required to provide a service is substantially greater than typically required. Modifier 22 is not a hospital approved modifier. The appropriate use of this modifier is subject to payer discretion and typically will trigger individual claim review. Specifically, CMS restricts the use of modifier -22 to only surgical procedures that have a global period of 0, 10, or 90 days. For Medicare claims, it would be inappropriate to append modifier -22 to cardiovascular ultrasound procedures.
The following modifiers may be appropriate for all echocardiography codes, depending upon the circumstances:
-51 Multiple Procedures: When multiple procedures, other than E/M services, Physical Medicine and Rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. The additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). Note: This modifier should not be appended to designated "add-on" codes.
-52 Reduced Services
This modifier is used to describe a service or procedure that is partially reduced or eliminated. It is approved for physician and hospital use. As an example, this modifier can be used to report an arterial extremity study (93922-52) on a patient with an above the knee amputation, since the procedure was not performed in its entirety.
-59 Distinct Procedural Service:
This modifier is used to report procedures that are not normally reported together but are appropriate under the circumstances. Modifier59 is used to clearly designate non routine instances when distinct and separate multiple services are provided to a patient on a single date of service. It is approved for physician and hospital use. Modifier -59 should only be used if no other modifier more appropriately describes the relationships of the two or more procedure codes. As an example, if a transthoracic echo (93306) is done for a particular indication, and based on the result, a TEE is also performed; the 59 modifier would be appended to the TEE (93312).
77 Repeat Procedure by Another Physician:
This modifier defines a repeat procedure by another physician during the same patient encounter. It is approved for physician and hospital use. As an example, when a TEE procedure is repeated by another physician, the second exam would require use of the 77 modifier and assumes that the second physician was aware this was a repeat procedure. For example, if a different physician acquires additional images, interprets, and prepares a report in addition to the preoperative TEE, then 93314 (image acquisition, interp/report) or 93317 (congenital image acquisition, interp/report) can be reported with modifier -77. This indicates that the additional image acquisition and interpretation was provided by a different physician. The medical record should reflect the medical necessity for repeating these procedures.
{D0535927.DOCX / 1 }May 2014 ASE Coding and Reimbursement Newsletter – A Membership Benefit- www.asecho.org CPT Copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
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ICD-10 New Code Set Implementation is Delayed
The Protecting Access to Medicare Act of 2014, which delayed the scheduled 24% cut to Medicare physician reimbursement rates ,also pushed the implementation of the new ICD-10 code set from October 2014 to no sooner than October 2015.
Accordingly, the U.S. Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.
The postponement allows for more time to strengthen clinical documentation improvement programs, and training for the eventual transition to ICD-10 codes.
This newsletter is for information purposes only. No guarantee of payment is stated or implied. It is the responsibility of the health care provider to properly code and to seek reimbursement for rendered medically appropriate and necessary services.
CPT Copyright 2012 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
