CMS Announces Final Rule for 2013 Physician Fee Schedule

Rule Expands MPPR-PC to Multiple Physicians in the Same Group Practice

The Centers for Medicare & Medicaid Services (“CMS”) announced today the 2013 Medicare Physician Fee Schedule (“MPFS”) Final Rule with comment period. The MPFS determines how physician and non-physician practitioner services rendered in 2013 will be paid. Barring any unforeseen subsequent changes, these new rules will be effective starting January 1st, 2013.

Of particular importance is CMS’ decision to expand the Professional Component Multiple Procedure Payment Reduction (“MPPR-PC”) for certain advanced diagnostic imaging procedures to multiple physicians within the same group practice (i.e. same group NPI).

For advanced diagnostic imaging services (CT, MRI, and ultrasound) furnished on or after January 1st, 2013, CMS will now apply a twenty-five percent (25%) MPPR-PC to the second and subsequent procedures furnished to the same beneficiary in the same session on the same day by a single physician or by multiple physicians within the same group practice.

The MPPR-PC was originally announced in the 2012 MPFS Final Rule. However, due to “operational limitations”, CMS applied the MPPR-PC only when the same physician provided the interpretations. CMS has resolved the “operational limitations”, and will now apply the MPPR-PC to advanced diagnostic imaging services furnished by one or more physicians in the same group practice to the same beneficiary, in the same session, on the same day. The procedure with the highest PC reimbursement will be paid in full, while the PC reimbursement for each subsequent procedure furnished to the same patient, in the same session, on the same day will be reduced by 25%. While the MPPR-PC reduction will apply to the less expensive procedure, it will cut across modalities. For example, if a patient receives an MRI of the brain and a CT of the chest in the same session on the same day, the reimbursement for the CT of the chest (the less expensive procedure) will be decreased by 25%.

2013 MPFS Final Rule:

http://www.ofr.gov/OFRUpload/OFRData/2012-26900_PI.pdf

Best regards,
Andre Perrotta, Esq.
Chief Compliance Officer