July Brings Several Physician Service Code Updates

Here’s a summary of the changes for the July update to the 2018 Medicare Physician Fee Schedule Database (MPFSDB). Changes are effective for dates of service on and after July 1, 2018.

Indicator Change for RHC and FQHC Care Management Codes.

For the following two HCPCS Level II codes, the PC/TC indicator is changed to 0 (zero) Full service only (physician service codes) modifiers 26 and TC are not valid:

G0511 Rural health clinic or federally qualified health center (RHC or FQHC) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month

G0512 Rural health clinic or federally qualified health center (RHC or FQHC) only, psychiatric collaborative care model (psychiatric cocm), 60 minutes or more of clinical staff time for psychiatric cocm services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month

Beginning Jan. 1, 2018, RHCs and FQHCs must use the new General Care Management code G0511 when billing for chronic care management (CCM) or general behavioral health integration (BHI) services, and the new psychiatric collaborative care model (CoCM) code G0512 when billing for psychiatric C0CM services, either alone or with other payable services on an RHC or FQHC claim.

To bill G0511, an RHC or FQHC must meet the requirements for either CCM (CPT 99490 or 99487) or general BHI (CPT 99484). If the requirements for 99484 are met, the code can be billed and certified EHR technology is not required.

Old Code, New RVUs:
The following changes for HCPCS Level II code G0460 Autologous platelet rich plasma for chronic wounds/ulcers, including phlebotomy, centrifugation, and all other preparatory procedures, administration and dressings, per treatment are effective July 1, 2018:

Change Status = A, Work RVU = 2.25, Non-facility PE RVU = 2.89, Facility PE RVU = .94, Malpractice RVU = .34, Multiple Procedure = 2, Bilateral Surgery = 0, Assisted Surgery = 1, Co-surgery = 0, Team Surgery = 0, Global Days = 000.

PE RVU Change for Imaging Code:
The July Update also brings a change to the practice expense relative value unit (PE RVU) for CPT 71045 X-ray exam chest 1 view:

71045 – Facility and Non-facility PE RVU = 0.42
71045-TC – Facility and Non-facility PE RVU = 0.35

Indicator Change for New Q Codes:
The new for 2018 Q9991, Q9992, Q9993, and Q9995 injection codes are assigned procedure status E Excluded from physician fee schedule by regulation. These codes are for items and/or services that CMS chose to exclude from the fee schedule payment by regulation. No RVUs or payment amounts are shown and no payment may be made under the fee schedule for these codes. Payment for these codes, when covered continues under reasonable charge procedures, effective July 1, 2018.

New CPT Category III Codes:
The following new CPT Category III codes were accepted by the CPT Editorial Panel at the September 2017 meeting and, following a six-month implementation period, are effective for dates of service on or after July 1, 2018:

Code 0505T:
Endovenous femoral-popliteal arterial revascularization, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, all catheterization(s) and intraprocedural roadmapping and imaging guidance necessary to complete the intervention, all associated radiological supervision and interpretation, when performed, with crossing of the occlusive lesion in an extraluminal fashion

►(0505T includes all ipsilateral selective arterial and venous catheterization, all diagnostic imaging for ipsilateral, lower extremity arteriography, and all related radiological supervision and interpretation)◄

►(Do not report 0505T in conjunction with 37224, 37225, 37226, 37227, 37238, 37239, 37248, 37249 within the femoral-popliteal segment)◄

►(Do not report 76937 in conjunction with 0505T for ultrasound guidance for vascular access)◄

Code 0506T:
Macular pigment optical density measurement by heterochromatic flicker photometry, unilateral or bilateral, with interpretation and report

Code 0507T:
Near-infrared dual imaging (ie, simultaneous reflective and trans- illuminated light) of meibomian glands, unilateral or bilateral, with interpretation and report

►(For external ocular photography, use 92285)◄

►(For tear film imaging, use 0330T)◄

Code 0508T:
Pulse-echo ultrasound bone density measurement resulting in indicator of axial bone mineral density, tibia.

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