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Member Participation Critical for 5-Year Review Process

The Centers for Medicare and Medicaid Services (CMS) has released the list of existing CPT® codes that are perceived as potentially misvalued, as part of the third 5-year review of the Medicare Fee Schedule (MFS). There are 39 radiology codes on this list, including interventional, computed tomography (CT), magnetic resonance (MR), ultrasound, radiation oncology, plain film, dual energy x-ray absorptiometry (DXA), and nuclear medicine codes. The survey process will begin in late May and continue through the summer.

In order for the ACR to make recommendations to the Relative Value Update Committee (RUC) on physician work, it will need to obtain a large number of surveys for these codes. It is crucial that ACR members actively participate in the survey process since over 90% of RUC recommendations for physician work RVUs have been accepted by CMS for its fee schedule, which then may be used by other payers as well.

If you and other radiologists or radiation oncologists in your practice would like to help complete surveys, please call the Economics and Health Policy Department at (800) 227-5463, ext 4584, or send an e-mail to economics@acr.org with your name and the type of survey(s) you would like to receive (ie, MR, CT, nuclear medicine, plain film, DXA, interventional, or ultrasound).

Radiology Codes Included in the 5-Year Review

The table below lists radiology codes in the 5-year review, allowed services, the specialty society that submitted the code, and the physician work value as published in the 2005 MFS.

Background

With the implementation of Medicare's resource-based relative value scale physician fee schedule in January 1992, a review of the relative value units associated with CPT® codes has been required by Congress no less than every 5 years. This review serves as a mechanism for CMS to identify misvalued codes and update them accordingly. Currently the review focuses only on the physician work component of specific procedures paid under the MFS. However, future reviews will include the practice expense (technical) component when the resource-based values are established in the MFS.

The list of codes compiled for the current 5-year review is based on comments CMS requested from the medical community and carrier medical directors to identify and nominate misvalued procedures, as well as CMS' own review. The list contains high-volume codes across specialties, codes that have not previously been reviewed by the RUC, and codes that were valued as being performed in the inpatient setting, but are now predominantly performed on an outpatient basis.

The data collected by the ACR will be presented to the RUC early in the fall. The values accepted by the RUC will be submitted to CMS for review by the end of this year. The final revised work values are expected to be released in November 2006 for a January 1, 2007, implementation. <

It is important to note that although CMS is soliciting public comments and involving the RUC and specialty organizations, CMS will ultimately decide whether the physician work value for the identified misvalued code will be increased or decreased.

If you have any questions regarding the 5-year review process, please contact the ACR Economics and Health Policy Department at (800) 227-5463, ext 4584, or send an e-mail to economics@acr.org.