Prostate biopsy, flow cytometry cuts finalized in 2018 Medicare Physician Fee Schedule

Posted by on Nov 6, 2017 in Latest News | Comments Off on Prostate biopsy, flow cytometry cuts finalized in 2018 Medicare Physician Fee Schedule

Prostate biopsy, flow cytometry cuts finalized in 2018 Medicare Physician Fee Schedule

Pathologists who are still reeling from proposed PAMA-induced cuts for next year’s clinical lab fee schedule should be relieved to learn CMS made few significant changes to key pathology codes on the final 2018 Physician Fee Schedule.

The most significant adjustment from the proposed rule that was released earlier this year involves a bump to 88184 (flow cytometry, first marker). After initially proposing a slight cut from 2017 rate of $61.73, CMS backtracked and instead elected to boost the payment for 2018 to $68.02, an increase of 9.2 percent.

Beyond that change, most codes saw only minor adjustments of roughly a percent from what was proposed earlier this year. As expected, the biggest hits will impact the Global and Technical reimbursements for prostate biopsies (G0416). CMS is proposing to dock the Global rate by 11.5 percent and the Technical component by a whopping 18.7 percent, dropping their totals to $434.40 and $247.61, respectively.

The other key cuts will be experienced by flow cytometry codes 88185-TC and 88189-26, with the technical side expected to be cut by 18.8 percent to $30.59 and the professional interpretation set to experience a 4 percent reduction to $88.90.

Perhaps most surprisingly, CMS also announced it will reduce the 2018 Value Modifier penalty for those who failed to meet 2016 PQRS criteria from negative 4 percent to negative 2 percent for groups of 10 or more, and from negative 2 percent to negative 1 percent for groups of two to nine. Similar to reducing the number of required quality measures under PQRS from nine to six, CMS said the changes to the Value Modifier penalties were made to better bring the program in line with current Merit-based Incentive Payment System requirements.

The final conversion factor for 2018 is 35.9903, a slight bump over the 2017 rate of $35.8887. The overall update to payments under the PFS based on the proposed 2018 rates is .41 percent. The update reflects the .5 percent annual increase established under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, reduced by -.09 percent due to the misvalued code target recapture amount, according to CMS.

CPT Code Service Final 2018 Current 2017 Change
88112 – Global Cytopath cell ehance tech $70.18 $68.91 1.8%
88112 – TC Cytopath cell ehance tech $40.67 $39.84 2.1%
88112 – 26 Cytopath cell ehance tech $29.51 $29.07 1.5%
88121 – Global Cytp urine 3-5 probes cmptr $541.65 $553.76 -2.2%
88121 – TC Cytp urine 3-5 probes cmptr $489.64 $501.72 -2.4%
88121 – 26 Cytp urine 3-5 probes cmptr $52.19 $52.04 0.3%
88184 – TC Flowcytometry/ 1st marker $68.02 $61.73 9.2%
88185 – TC Flowcytometry/ additional marker $30.59 $37.68 -18.8%
88189 – 26 Flowcytometry/ read 16+ $88.90 $92.59 -4.0%
88305- Global Tissue exam by pathologist $70.18 $69.62 0.8%
88305 – TC Tissue exam by pathologist $30.23 $29.79 1.5%
88305 – 26 Tissue exam by pathologist $39.95 $39.84 0.3%
88307 – Global Level V, tissue exam by pathologist $269.93 $269.88 0.1%
88307 – TC Level V, tissue exam by pathologist $182.11 $181.96 0.1%
88307 – 26 Level V, tissue exam by pathologist $87.82 $87.93 -0.1%
88309 – Global Tissue exam by pathologist $409.93 $413.80 -0.9%
88309 – TC Tissue exam by pathologist $254.09 $258.40 -1.7%
88309 – 26 Tissue exam by pathologist $155.84 $155.40 0.3%
88312 – Global Special stains group 1 $99.33 $99.97 -0.6%
88312 – TC Special stains group 1 $71.26 $71.42 -0.2%
88312 – 26 Special stains group 1 $28.07 $28.35 -1.0%
88313 – Global Special stains group 2 $71.98 $70.70 1.8%
88313 – TC Special stains group 2 $59.38 $58.14 2.1%
88313 – 26 Special stains group 2 $12.60 $12.56 0.3%
88341 – Global Immunohistochemistry (additional stain) $94.65 $92.23 2.6%
88341 – TC Immunohistochemistry (additional stain) $64.78 $62.45 3.6%
88341 – 26 Immunohistochemistry (additional stain) $29.87 $29.79 0.3%
88367 – Global Insitu hybridization auto $109.40 $107.31 2.0%
88367 – TC Insitu hybridization auto $73.06 $71.06 2.7%
88367 – 26 Insitu hybridization auto $36.35 $36.25 0.3%
88368 – Global Insitu hybridization manual $123.45 $118.43 4.1%
88368 – TC Insitu hybridization manual $79.90 $76.08 4.8%
88368 – 26 Insitu hybridization manual $43.55 $42.35 2.8%
G0416 – Global Prostate biopsy $434.40 $490.96 -11.5%
G0416 – TC Prostate biopsy $247.61 $304.70 -18.7%
G0416 – 26 Prostate biopsy $186.79 $186.26 0.3%