What pathologists can expect from the 2018 Medicare Physician Fee Schedule

Posted by on Jul 17, 2017 in Latest News | Comments Off on What pathologists can expect from the 2018 Medicare Physician Fee Schedule

What pathologists can expect from the 2018 Medicare Physician Fee Schedule

After significantly cutting the technical component for a number a key of pathology CPT codes last year, pathologists should be relieved to hear the vast majority of reimbursements levels are expected remain relatively unchanged next year, according to the proposed 2018 Medicare Physician Fee Schedule.

The biggest hit will again 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. This comes as little surprise, as CMS has slashed payment for prostate biopsies throughout the past half-decade.

The other most significant cut 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 4.4 percent reduction to $88.54.

Bad news aside, pathologists will be happy to hear all components of 88305 will receive a slight boost this year after seeing its technical and global component slashed by 15 percent and 7 percent, respectively, last year when compared to 2016 compensation rates. Professional interpretations for 88305 will jump 1.2 percent to $40.31, while Global and Technical reimbursement will both experience increases of less than 1 percent.

Overall, CMS anticipates their proposed 2018 amendments will cut pathologists overall compensation rates by just 1 percent, while independent labs will see a 2 percent reduction.

Keep in mind that the conversion factor for 2017 was $35.8887, while the proposed factor for 2018 is 35.9903. The overall update to payments under the PFS based on the proposed 2018 rates would be .31 percent. The update reflects the .5 percent annual increase established under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, reduced by -.19 percent due to the misvalued code target recapture amount, according to CMS.

Check out the chart below for a breakdown of the major proposed changes for several key pathology codes. In the spirit of brevity, code sets expected to see cuts or boosts of less than 1 percent were not listed.

CPT Code Service Proposed 2018 Current 2017 Change
88112 – Global Cytopath cell ehance tech $69.82 $68.91 1.3%
88112 – TC Cytopath cell ehance tech $40.31 $39.84 1.2%
88112 – 26 Cytopath cell ehance tech $29.51 $29.07 1.5%
88121 – Global Cytp urine 3-5 probes cmptr $536.26 $553.76 -3.2%
88121 – TC Cytp urine 3-5 probes cmptr $484.07 $501.72 -3.5%
88121 – 26 Cytp urine 3-5 probes cmptr $52.19 $52.04 0.3%
88184 – TC Flowcytometry/ 1st marker $61.18 $61.73 -0.9%
88185 – TC Flowcytometry/ additional marker $30.59 $37.68 -18.8%
88189 – 26 Flowcytometry/ read 16+ $88.54 $92.59 -4.4%
88305- Global Tissue exam by pathologist $70.18 $69.62 0.8%
88305 – TC Tissue exam by pathologist $29.87 $29.79 0.3%
88305 – 26 Tissue exam by pathologist $40.31 $39.84 1.2%
88307 – Global Level V, tissue exam by pathologist $268.49 $269.88 -0.5%
88307 – TC Level V, tissue exam by pathologist $180.67 $181.96 -0.7%
88307 – 26 Level V, tissue exam by pathologist $87.82 $87.93 -0.1%
88309 – Global Tissue exam by pathologist $407.41 $413.80 -1.5%
88309 – TC Tissue exam by pathologist $251.57 $258.40 -2.6%
88309 – 26 Tissue exam by pathologist $155.84 $155.40 0.3%
88312 – Global Special stains group 1 $98.61 $99.97 -1.4%
88312 – TC Special stains group 1 $70.18 $71.42 -1.7%
88312 – 26 Special stains group 1 $28.43 $28.35 0.3%
88313 – Global Special stains group 2 $71.62 $70.70 1.3%
88313 – TC Special stains group 2 $58.66 $58.14 0.9%
88313 – 26 Special stains group 2 $12.96 $12.56 3.2%
88341 – Global Immunohistochemistry (additional stain) $93.21 $92.23 1.1%
88341 – TC Immunohistochemistry (additional) $63.34 $62.45 1.4%
88341 – 26 Immunohistochemistry (additional) $29.87 $29.79 0.3%
88367 – Global Insitu hybridization auto $108.33 $107.31 1.0%
88367 – TC Insitu hybridization auto $71.98 $71.06 1.3%
88367 – 26 Insitu hybridization auto $36.35 $36.25 0.3%
88368 – Global Insitu hybridization manual $122.73 $118.43 3.6%
88368 – TC Insitu hybridization manual $79.54 $76.08 4.5%
88368 – 26 Insitu hybridization manual $43.19 $42.35 2.0%
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%