CMS Proposed Payment Changes to Result in Anesthesia Reimbursement Reduction

    By: Kate Maude on Aug 31, 2017

    Dear First Name,

    This summer, the Centers for Medicare & Medicade Services (CMS) issued a proposed rule that will impact payment policies and rates for anesthesia services provided under the Medicare Physician Fee Schedule, particularly for anesthesia procedures for colonoscopies. These changes are set to go into effect on or after January 1, 2018. The original document can be viewed here, and the electronic comment form is available here

    The proposed changes to CPT codes for colonoscopies are based on a CMS review in 2016 of Medicare claims that showed "a separate anesthesia service is typically reported more than 50 percent of the time that various colonoscopy procedures are reported." Based on this information, CMS is proposing that the related colonoscopy CPT codes are incorrectly valued.

    The resulting new rule includes new CPT codes for 2018. Instead of the current two CPT codes (00740 for Aneshtesia for Upper GI Visualization and 00810 for Anesthesia for Lower Intestine Scope,) CMS is proposing the new codes below:

    Old CPT Code

    New CPT Code

    Old Base Units

    New Base Units

    Variance in Units

    00740

    007X1

    5

    5

    0%

    00740

    007X2

    5

    6

    +20%

    00810

    008X1

    5

    4

    -20%

    00810

    008X2

    5

    4

    -20%

    00810

    008X3

    5

    5

    0%

    Additionally, a recommendation from the CMS RVC Update Committee (RUC) is calling for the reduction of CPT 008X2 from the new base unit value of 4 down to 3 base units. This reduction in base units will reduce reimbursement for the impacted CPT codes by between 14% and 28%, based on an average of 7.2 total units billed. We reject the notion that increased utilization should be used to justify a decrease in base units for anesthesia for colonoscopy and encourage all anesthesia providers to reach out to CMS to oppose the decrease in CPT Code Base Points for 008X1 and 008X2.

    For more informaiton on this change and to read the full proposed rule, please visit the CMS Factsheet here and the full rule PDF available here. We also recommend reviewing the ASA summary of changes impacting anesthesiology practice here.  

    All comments must be received by CMS by Monday, September 11, 2017. To submit comments, please follow the instructions below:

    • Electronically: please submit comments here through the Federal Government Regulations website.
    • By regular mail: You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1676-P, P.O. Box 8016, Baltimore, MD 21244-8013. Please allow sufficient time for mailed comments to be received before the close of the comment period.
    • By express or overnight mail: You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1676-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.

    Questions? Please contact us at info@sambahq.org if you have any questions or concerns about this message.

    Released: August 31, 2017, 7:50 am
    Keywords: Announcements