MPFS Update: Dozens of Payment Indicator Changes

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August 31, 2011
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Effective Oct. 3, Medicare contractors will implement an updated Medicare Physician Fee Schedule Database (MPFSDB), which will remain in effect until Jan. 1, 2012, according to the Centers for Medicare & Medicaid Services (CMS). Just under 50 codes will receive payment indicator changes in various categories, but no codes are being added or deleted for the fourth quarter update, and relative value units (RVUs) for all codes will remain unchanged.

Codes affected by payment indicator changes include:

  • Codes 21089 Unlisted maxillofacial prosthetic procedure; 38129 Unlisted laparoscopy procedure, spleen; and 58578 Unlisted laparoscopy procedure, uterus, among other unlisted procedure codes, now have a co-surgery indicator of “1” (Co-surgeons could be paid, though supporting documentation is required to establish the medical necessity of two surgeons for the procedure.).
  • Codes +15201 Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) and +19291 Preoperative placement of needle localization wire, breast; each additional lesion (List separately in addition to code for primary procedure) now have an “assistant at surgery” indicator of “1” (Assistant at surgery may not be paid); and +14302 Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or part thereof (List separately in addition to code for primary procedure) now has an “assistant at surgery” indicator of “2” (Assistant at surgery may be paid).
  • Codes 95928 Central motor evoked potential study (transcranial motor stimulation); upper limbs and 95929 Central motor evoked potential study (transcranial motor stimulation); lower limbs (for professional, technical, and global services) have been granted a “bilateral surgery” indicator of “2” (150 percent payment adjustment does not apply).
  • The diagnostic supervision requirement for 20 codes has been revised.
  • Approximately two dozen codes are newly assigned a “1” indicator for team surgery (Team surgeons could be paid, although supporting documentation is required to establish medical necessity of a team; pay by report.).

The complete list of affected codes and MPFS payment indicator changes can be found in CMS Transmittal 2276, Change Request (CR) 7528 on the CMS website. Also available is MLN Matters® article MM7528.

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