Medicare Physician Fee Cuts Delayed

Cuts in Medicare payments to physicians in 2010 were delayed until March when the U.S. Senate approved a $636 billion military appropriations bill on Dec. 19. The bill includes a provision delaying Centers for Medicare & Medicaid Services (CMS) plans to reduce Medicare payments by 21.2 percent beginning March 1, 2010.

The House had already passed the bill.

TMA will continue to push Congress to adopt a permanent fix to institute a fair payment system that automatically keeps up with the cost of running a practice and is backed by a fair, stable funding formula.

Earlier in December, TMA and other state medical associations across the country joined AMA in urging Congress to establish "a pathway for a permanent repeal" of the Sustainable Growth Rate (SGR) formula upon which Medicare fees are based. The 21.2-percent fee reduction would have compromised access to care for Medicare patients and for military families whose TRICARE coverage is based on Medicare rates, the groups said in a letter to lawmakers.

The groups said in the letter that Congress has "repeatedly 'kicked the can' to postpone imminent payment cuts to future years …" They added that "the cost of repealing a formula whose faults have been known since its inception has continued to grow, from $49 billion in 2005 to over $200 billion today."

Consultation Payments Eliminated

Postponement of the Medicare fee cuts does not affect other payment policies included in the final 2010 CMS fee schedule. They will take effect on schedule on Jan. 1. A new physician fee schedule will be in effect from 1/1/10 to 2/28/10. The official version of the fee schedule will be posted on the Trailblazer website when it is available.

Those policies include revisions to the consultation services payment policy [PDF] CMS will implement next year. CMS will no longer pay physicians for consultations using the CPT consultation codes. The consultation codes comprise 99241-99244 for office or other outpatient consults and 99251-99255 for inpatient consultations. Instead, CMS instructed physicians to bill using the new or established patient codes. The link above provides details on the new policy and describes how physicians should bill Medicare for consults. 

The American Medical Association asked CMS to delay the consultation policy for a year. CMS has not acted on the request.

TMA's payment advocacy staff developed answers to these frequently asked questions about the consultation codes:

Q. Are the commercial carriers planning to follow the CMS elimination of consultation codes?

A. At this time, none of the commercial carriers have issued guidance regarding elimination of consultation codes. As soon as we receive responses, we will share them with TMA members.

Q. Is there a modifier to indicate the principal physician of record for inpatient visits?

A. Yes. CMS guidance from the MLN Matters Number MM6740 [PDF] article says, "The principal physician of record will append modifier "-AI" Principal Physician of Record, to the E/M code when billed. This modifier will identify the physician who oversees the patient's care from all other physicians who may be furnishing specialty care. All other physicians who perform an initial evaluation on this patient will bill only the E/M code for the complexity level performed."

Q. If the patient's primary insurance still accepts consultation codes and their secondary insurance is Medicare, how should I bill the service?

A. CMS guidance says you may bill one of two ways:

  • Bill the primary payer an E/M code that is appropriate for the service and then report the amount actually paid by the primary payer, along with the same E/M code, to Medicare for determination of whether a payment is due; or
  • Bill the primary payer using a consultation code that is appropriate for the service and then report the amount actually paid by the primary payer, along with an E/M code that is appropriate for the service, to Medicare for determination of whether a payment is due.

Decision Time

CMS has extended the 2010 Annual Participation Enrollment Program end date from January 31, 2010, to March 17, 2010- therefore, the enrollment period now runs from November 13, 2009, through March 17, 2010.
The effective date for any Participation status change during the extension, however, remains January 1, 2010, and will be in force for the entire year.
Contractors will accept and process any Participation elections or withdrawals, made during the extended enrollment period that are received or post-marked on or before March 17, 2010.

TMA is planning a Webinar on Medicare issues for early January. Check future issues of Action for details.

Signing a participation agreement means you agree to accept assignment for all covered services that you provide to Medicare patients in 2010. CMS says fees are 5 percent higher for physicians who participate.

If you choose to participate in 2010:

  1. Do nothing if you currently participate.
  2. If you are not currently a Medicare participant, complete the agreement and mail it to TrailBlazer Health Enterprises, the Texas Medicare carrier.

If you decide not to participate:

  1. Do nothing if you do not currently participate.
  2. If you are currently a participant, write to each Medicare contractor to which you submit claims, advising of your termination effective Jan. 1, 2010.

The Participation Agreement (CMS-Form 460) is available on the CD-ROM distributed by TrailBlazer Health Enterprises and is posted on the TrailBlazer Web site. 

Return the form to:

Medicare Part B
Participation Agreement
PO Box 650544
Dallas, TX 75265-0544  

TMA's Medicare Meltdown Action Center

Action Special Issue, Dec. 19, 2009

Last Updated On

October 20, 2017

Originally Published On

March 24, 2010

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