Prep Time! July 2018 MPFS Updates Bring More Than RVU Changes

July 2018 MPFS update

We’re a month away from the July 2018 Medicare Physician Fee Schedule (MPFS) update. These quarterly changes are easy to overlook, but checking any fee schedule update is important. Even if, for some reason, you’re not interested in RVU changes, there may be changes to indicators (like PC/TC) that affect proper reporting. Here are some areas to watch for the July 2018 MPFS changes related to already existing codes.

Note: Instead of the usual July 1, Medicare lists the implementation date for these changes as July 2, 2018, a Monday, so that’s when payers are required to implement the changes.

Jump on G0511 and G0512 Changes for RHCs and FQHCs

RHCs and FQHCs may be interested in this change. The following two codes will have a PC/TC indicator change from 9 (Not applicable) to 0 (Physician service codes), effective back to Jan. 1, 2018.

  • G0511 (Rural health clinic or federally qualified health center (RHC or FQHC) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an RHC or FQHC practitioner (physician, NP, PA, or CNM), per calendar month)
  • G0512 (Rural health clinic or federally qualified health center (RHC or FQHC) only, psychiatric collaborative care model (psychiatric COCM), 60 minutes or more of clinical staff time for psychiatric COCM services directed by an RHC or FQHC practitioner (physician, NP, PA, or CNM) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month).

You should not use modifiers 26 or TC with codes that have PC/TC indicator 0 on the MPFS, so this likely won’t cause a change to how you’ve been reporting those codes.

Check Status Change for Chronic Wound Treatment G0460

Heads up if you perform the services described by G0460 (Autologous platelet rich plasma for chronic wounds/ulcers, including phlebotomy, centrifugation, and all other preparatory procedures, administration and dressings, per treatment).

This code is changing from status C, which means carriers determine coverage and price, to status A, which means active. As part of this change, effective back to Jan. 1, 2018, the MPFS sets RVUs and makes some changes to indicators, too.

Here is information for G0460 from the July 2018 update, with explanations added for certain fields:

  • Status = A (Active)
  • Work RVU = 2.25
    • The work RVU is based on debridement codes 11042 x1 and 11045 x2 plus 99195 x1 (phlebotomy) and 38213 x1 (transplant prep, platelet depletion).
  • Non-Facility PE RVU = 2.89
  • Facility PE RVU = .94
    • Direct PE inputs crosswalk from debridement code 11042 plus additional labor, supplies, and equipment.
  • Malpractice RVU = .34
  • Mult Proc = 2 (Standard payment adjustment rules for multiple procedures apply.)
  • Bilat Surg = 0 (150 percent payment adjustment for bilateral procedures does not apply.)
  • Asst Surg = 1 (Assistants at surgery may not be paid.)
  • Co-Surg = 0 (Co-surgeons not permitted for this procedure.)
  • Team Surg = 0 (Team surgeons not permitted for this procedure.)
  • Global Days = 000 (Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable.)

Remember: With retroactive changes like this one, you can bring claims to your MAC’s attention for payment. (Keep that in mind for the next section about 71045, too.) For instance, if you reported G0460 in the first quarter of the year, and your payer didn’t cover it, it may be worth your time to contact the payer for payment after the change is implemented, especially if multiple claims are involved.

Expect a Little More for Chest X-Ray Code 71045

Chest X-ray code 71045 (Radiologic examination, chest; single view) will see changes to the facility and non-facility PE RVUs for both the global and technical component:

  • 71045: change from 0.36 to 0.42
  • 71045-TC: change from 0.29 to 0.35.

This change is also effective back to Jan. 1, 2018.

What About You?

Will any of these changes affect you? Don’t forget there are MPFS updates related to new codes effective July 1, 2018, too, like HCPCS Q codes and Category III codes.

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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