Turn Back Time With These 2018 MPFS Updates

Retroactive Medicare fee schedule changes


Keeping up with 2018 updates to the Medicare Physician Fee Schedule (MPFS) is one thing. Knowing which ones are retroactive adds a whole other level to ensuring you’re applying the right information to your claims. Today we’re covering two groups of retroactive MPFS changes.

Watch for Work GPCI Floor Increase

If you’re in an area where the work Geographic Practice Cost Index (GPCI) started 2018 below 1.000, keep an eye on communications from your Medicare contractor. The Bipartisan Budget Act of 2018, passed on Feb. 9, changed the work GPCI floor to 1.000. This is an extension. A previous rule set the floor at 1.000 for dates of service (DOS) before Jan. 1, 2018, and the new wording changes that to DOS before Jan. 1, 2020.

Do this: Make sure the local fee information you have is up to date. Watch for news of adjustments to prior claims, too, because the change is retroactive. For instance, National Government services announced by email, “We are currently working with CMS for adjusting previously paid claims. Information will be shared as it becomes available.”

Check for April MPFS Changes Effective Jan. 1

The April 2018 updates to the MPFS database include some changes retroactive to Jan. 1, 2018, too. For these retroactive changes, Medicare doesn’t require contractors to search files to adjust payment, but if you bring claims to their attention, they’ll adjust claims. (These particular changes may not merit that level of work on your part, but be sure to watch for that statement any time there’s a retroactive change that could benefit your practice.)

Here are some highlights from the changes to be implemented April 2 (a Monday) and effective back to Jan. 1, 2018:

  • G0516 (Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant))
    • Change: Revise the short description from “Insert drug del implant, >4” to “insert drug implant,>=4,” bringing the short descriptor in line with the “4 or more” requirement in the long descriptor.
  • G9976 and G9977, measure codes for dilated macular exam
    • Change: Switch the code status from M (measurement codes) to I (not valid for Medicare purposes). Note that code G9892 has the same descriptor as G9976, and G9893 has the same descriptor as G9977. Both G9892 and G9893 are related to MIPS measure 14 about age-related macular degeneration. Codes G9892 and G9893 have code status M.
  • 45399 (Unlisted procedure, colon)
    • Change: The global days indicator changes from XXX (concept does not apply) to YYY (carrier determines whether the global concept applies and establishes post-op period). In other words, the change allows carriers to determine the global period for this unlisted-procedure code when they determine pricing.
  • 83992 (Phencyclidine (PCP))
    • Change: The procedure status will change from X (statutory exclusion) to I (not valid for Medicare purposes). The Clinical Lab Fee Schedule prices the related definitive drug testing code G0480 at $114.43.

What About You?

Have you ever benefited from a retroactive change? Will you benefit from the work GPCI floor change?


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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