CMS has released the 2018 rules that finalize policy and payment changes for the Medicare Physician Fee Schedule (PFS) and the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Centers (ASC) Payment System.
The PFS final rule will appear in the Federal Register on Nov. 15 and OPPS and ASC final rule on Nov. 13.
2018 Medicare Physician Fee Schedule Final Rule.
2018 Proposed Conversion Factor: The 2018 MPFS conversion factor is $35.9996, an increase of +0.41 percent from the 2017 PFS conversion factor of $35.89. This update reflects the +0.50 percent update established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), reduced by 0.09 percent, due to the misvalued code target recapture amount, required under the Achieving a Better Life Experience Act of 2014.
CY 2018 national average Anesthesia conversion factor at $22.1887, both of which reflect a modest payment increase under the Medicare Access and CHIP Reauthorization Act (MACRA)
Payment Changes for Anesthesia for GI Procedures: For CY 2018, the AMA CPT Editorial Panel is deleting CPT codes 00740 (Anesthesia for upper GI procedures) and 00810 (Anesthesia for lower GI procedures) and replacing them with the following five new codes. The current CY 2017 base unit for upper and lower GI is 5 base units.
CMS finalized the following values for CY 2018:
- 00731 (Anesthesia for upper GI, not otherwise specified) = 5 base units
- 00732 (Anesthesia for upper GI, ERCP) = 6 base units
- 00811 (Anesthesia for lower GI, not otherwise specified) = 4 base units
- 00812 (Anesthesia for screening colonoscopy) = 3 base units
- 00813 (Anesthesia for upper and lower GI during the same session) = 5 base units
Each base unit is approximately $22.
http://www.gastro.org/news_items/cms-releases-2018-medicare-payment-rules
https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-23932.pdf
https://www.lexology.com/library/detail.aspx?g=4392e0ea-5649-4f19-a20d-b765d78176ed
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-11-02.html
