Part 2: What Does the MPFS Proposed Rule Reveal About CPT® 2018?

2018 updates

Welcome to Part 2 of our look at what we can expect in CPT® 2018 based on what’s discussed in the Medicare Physician Fee Schedule 2018 Proposed Rule. Be sure to read Part 1 to get the complete picture. These are proposed codes, so of course keep checking back for in-depth updates once we start posting about the finalized 2018 code set.

Nervous System

Two proposed codes (64xxx) will apply to nerve repair with a nerve allograft. The first code is for the first strand, and you’ll report the second code for separate reporting of each additional strand.


Chest X-rays have four proposed options at 710xx: single view, 2 views, 3 views, and 4 or more views.

Three proposed abdomen X-ray codes (740xx) will have a similar structure, offering one option each for 1 view, 2 views, and 3 or more views. These abdomen codes will replace 74000 (single AP), 74010 (AP/oblique/cone), and 74020 (complete).

Pulmonary Procedures

Expect CPT® 2018 to delete simple pulmonary stress test code 94620 and add two new codes (946xx) for tests commonly used to evaluate dyspnea. One will cover an exercise test for bronchospasm, and the other will cover pulmonary stress testing like a 6-minute walk test.

Photodynamic Therapy

Two new photodynamic therapy codes (96xxx) are planned for premalignant lesions. These codes include the physician work in furnishing the service and are “per day” codes.

Physical Medicine and Rehab Evaluations

As part of revising the orthotic and prosthetic codes, the proposal is for 97760 (orthotic management and training) and 97761 (prosthetic training) to have the term “initial encounter” added. You’ll have a new code (977xx) for subsequent encounters. Assessment and fitting/adjustment code 97762 (Checkout for orthotic/prosthetic use, established patient, each 15 minutes) will be deleted.

There also will likely be a new code (97xxx) for one-on-one therapeutic interventions that focus on cognitive function and compensatory strategies. This code will replace 97532 (Development of cognitive skills …).

Watch for: Because 97532 is reported once for each 15 minutes and the proposed new code is reported once per day, Medicare may create a G code (a match to 97532) to use instead of the new 97xxx code. The time required for this service varies among the different provider types who report it, so Medicare wants to maintain use of a code that’s based on time.


The changes expected for E/M spread across a wide range of services.

INR monitoring: For anticoagulation management, the plan is to delete 99363 and 99364. In their place, you’ll have two new 993xx codes, one for patient/caregiver training for initiation of home INR monitoring and another for anticoagulation management. Medicare does not plan to delete related codes G0248-G0250 because they fall under a National Coverage Determination.

Psychiatric/behavioral health care management: Psychiatric collaborative care management likely will get three new codes (994xx) for initial, subsequent, and each additional 30 minutes in a calendar month. If you’re familiar with G0502, G0503, and G0504, then you’re familiar with the services covered and this code structure.

Another code related to that group is G0507 for behavioral health care management services. CPT® 2018 plans to add a 99xxx code that you’ll use instead of G0507.

Assessment and care planning for a patient with cognitive impairment looks set to get a new 99xxx code. The new code applies when the case requires an independent historian. The impressively long descriptor also details other requirements. Just a few examples are a cognition-focused evaluation, moderate or high medical decision making, functional assessment, and use of standardized instruments to stage dementia.

What Do You Think?

Do you see any changes you’ve been waiting for to make coding simpler? Are you worried about any of these changes?


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.


Leave a Reply