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Avastin Update - Patients Win with Immediate Avastin Payment Reversal
Following an aggressive joint campaign by the American Academy of Ophthalmology, the American Society of Retina Specialists, the Macula Society and the Retina Society, CMS indicates it will no longer recognize code Q2024 for payment of office-based claims, and practitioners are directed to return to their previous reporting practice for small intraocular doses of Avastin. CMS had implemented Q2024 with a payment of $7 on Oct. 1, creating a significant gap in Avastin payment for ophthalmology.
In its reversal, CMS said, “Effective immediately, CMS no longer recognizes Healthcare Common Procedure Coding System (HCPCS) Code Q2024 Avastin for payment of non-outpatient hospital claims. Practitioners shall return to their previous reporting practice for small intraocular doses of Avastin furnished prior to Oct. 1. HCPCS Code Q2024 will be deleted as of Jan. 1, 2010, and, therefore, it will be removed from the Average Sales Price pricing file effective with the January 2010 Release.” For facility-based services, the Q2024 will be in effect until Dec. 31. After that date, hospitals should use C9257 for any ophthalmic use of Avastin.
Medicare claims processing contractors are to post information pertaining to the reversal on their Web sites within five days to inform providers of this policy change. In addition, CMS has instructed Medicare contractors to reprocess any claims from physicians for Avastin administered in their offices that were paid based on the Q2024 code, if requested by the physician. The Academy advises members to check their carrier Web sites for further details and instructions.
If you have questions, contact the Academy’s Governmental Affairs office at 202.737.6662.
Consult-Code Elimination Enables E&M Payment Increase
As reported by the Academy this summer, CMS proposed to eliminate payment for consult codes; that proposal is finalized by the new 2010 rule. The Academy generally supported this concept because of the confusion caused by several changes in when consults were allowed. The money from these services will now go to increase payments for E&M visits, increasing payments for ophthalmology’s global surgical codes. The Academy will push to have the eye visit codes included in these increases, but we are pleased that CMS accepted the request we made, along with other surgical groups, to include the increases in visits bundled into global surgical services. The charts below provide an overview of what payments could look like in 2010, as compared to the rates published by CMS that reflect the -21.6 percent update.
2010 Ophthalmology Coding Update Webinar
Register today for the Jan. 12, 2010 one-hour webinar designed to help you identify the new coding rules and regulations to appropriately code for proper reimbursement
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PQRI Updates
- CMS has released the final measure specifications for 2010 Physician Quality Reporting Initiative
Visit the Academy's Advocacy page for all PQRI Updates.
- Introduction to PQRI Webinar Register today for the Dec. 8 one-hour webinar is designed to help those practices who are first time participants in PQRI reporting.
- 2010 PQRI & E-Prescribing Update Webinar Attend the Dec. 15 FREE one-hour webinar is designed to inform participating practices about 2010 PQRI and E-Prescribing reporting changes. Free registration however attendance is limited!
Medicare/CMS News
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Ophthalmologists See Significant Boost in Final 2010 Physician Fee Schedule
The 2010 Medicare physician payment final rule released on Oct. 30 will be published in the Federal Register on Nov. 25. Comments are due on Dec. 30. As the Academy reported last week, the rule establishes a 2010 payment update of -21.6 percent due to the series of short-term sustainable growth rate (SGR) fixes. The Academy is working to ensure Congress intervenes and eliminates the faulty SGR formula before Jan. 1. We also continue to seek a permanent repeal of the SGR.
In what is a substantial victory for ophthalmology, CMS has finalized adoption of the new practice expense (PE) survey that sets ophthalmology up for an 11 percent increase over four years. Even with a four-year phase in — a CMS compromise to several of the groups whose payments are significantly decreasing — ophthalmology will receive a 3 percent PE increase next year. That, combined with changes to professional liability insurance relative values for another 2 percent increase, brings ophthalmologists a total published increase of 5 percent in 2010, if the negative SGR update is halted.
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CMS Final Rule Published Oct. 30, 2009
View Final Rule PDF
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Important Medicare Enrollment Update
CMS has indicated that MDs are incorrectly filling for enrollment or practice location changes via internet based PECOS. A Medicare contractor will not process an Internet enrollment application without the signed and dated two-page Certification Statement and the required supporting documentation. Physicians must return the Certification Statement within seven of the electronic submission.
> Getting Started: Internet-based PECOS (PDF 52K)
> Medicare Program Integrity Manual (PDF 512K)
- Medicare Drug Pricing
- CMS 1500 Claim Form Instructions (PDF 546K)
- Revised Guidelines for Teaching Physicians, Interns and Residents (PDF 268K)
- Directory of Medicare Advantage Claims Processing Contacts
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CODEquest Seminars
Ophthalmic Coding Specialists (OCS)
Bulletins - Visit our Newsletters page for links to the current issue of AAOE News, The Coding Bulletin, Executive Update and Techniques.
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