Do You Land in the Winner Column for MPFS 2019?

For the 2019 Medicare Physician Fee Schedule (MPFS), we’ve talked about E/M and a bit about remote monitoring. But now let’s take a general overview of the ups and downs expected for individual specialties.

Know Where to Find the Info and What It Means

Table 94 of the 2019 MPFS final rule is titled “CY 2019 PFS Estimated Impact on Total Allowed Charges by Specialty.” The table shows allowed charges by specialty; impact of changes to work, practice expense, and malpractice RVUs; and the combined impact of the changes.

One important note when looking at these percentage changes is that it’s an overall expectation. But the impact on you may differ significantly from your specialty in general based on the actual services you provide and codes you report.

Tip: Compare 2018 and 2019 RVUs for your top codes to know what to expect next year. For a quick start, you can go to Medicare’s 2019 fee schedule page and download the file titled “CY 2019 PFS Final Rule Impact on Payment for Selected Procedures.” You’ll see a couple of eye-openers in this file of high-volume procedures, like -19 percent change for immunization admin code 90471 and a 4 percent increase for EGD biopsy code 43239.

Who’s Seeing the Most Positive Combined Impact?

According to the final rule, the RVU changes mostly come back to updates for misvalued codes. New and revised codes are also a factor.

Four specialties came out with increases a little higher than others mostly because of increases for particular services as well as higher payments for supply and equipment pricing and new payment policies for communication technology-based services:

  • Clinical psychologist, 3 percent
  • Interventional radiology, 2 percent
  • Podiatry, 2 percent
  • Vascular surgery, 2 percent.

The clinical social worker specialty also sees a 2 percent combined impact. And interestingly “Other” shows a 4 percent increase for combined impact.

One percent increases are expected for these additional specialties:

  • Audiologist
  • Colon and rectal surgery
  • Dermatology
  • Interventional pain management
  • Portable X-ray supplier
  • Psychiatry
  • Urology.

Who’s Going to See the Biggest Decrease?

The four specialties below are expecting decreases for reasons similar to those discussed above in the section about increases: revalued procedures and supply/equipment pricing changes. Phased-in reductions are a factor, as well:

  • Diagnostic testing facility, -5 percent
  • Independent labs, -2 percent
  • Pathology, -2 percent
  • Ophthalmology, -1 percent.

Keep in mind: These changes are for MPFS RVUs. If you get reimbursement based on other fee schedules, then you have to do some more math to determine the impact of MPFS changes on your Medicare payments. For instance, according to the final rule, the 2 percent MPFS lab reduction applies to only 17 percent of that specialty’s Medicare payments because so much of the lab payment is from the CLFS.

Other specialties expected to see a 1 percent decrease in 2019 include these:

  • Allergy/immunology
  • Chiropractor
  • Critical care
  • Hematology/oncology
  • Infectious disease
  • Nuclear medicine
  • Optometry
  • Physical/occupational therapy
  • Radiation oncology and radiation therapy centers.

What About You?

How do you expect your organization to do with the upcoming changes? Do you check for rate changes for your top 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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