Advocacy Council work results in code increases from 3 to 39%

The Centers for Medicare and Medicaid Services (CMS) released the 2017 Proposed Medicare Physician Fee Schedule on July 7, 2016. The following summary covers the most important allergy issues which the Advocacy Council of the ACAAI has been working on in conjunction with CMS. The proposed schedule is open for comment until September 6 and a final fee schedule for 2017 will be published in early November 2016.

1. Re-evaluation of CPT Codes 95144 and 95165

These codes were on the “potentially misvalued” code list in 2015 and were reviewed by the AMA’s Relative Value Update Committee at its January 2016 meeting. We are pleased to report this effort, led by the Advocacy Council, with support from the AAAAI and the AAOA, appears to have been successful in avoiding any downward adjustment in work RVUs.  We were also able to achieve a slight increase in practice expense RVU’s (0.01 RVU) due to the updating of supply items to reflect current practice as well as slight increases in clinical staff time to reflect additional work required to comply with USP guidelines.  While final numbers could vary slightly, under the proposed fee schedule, payment for both codes will increase from $12.89 to $13.24, an increase of $0.35 more per dose or an additional $3.50 per 10cc vial.  

2. Substantial Increase in Venom Immunotherapy Vials

Due to the Advocacy Council’s request and submission of new data, CMS is proposing to increase reimbursement for venom immunotherapy codes (CPT Codes 95145-95149) by between 16% and 39% to reflect the increased cost of venom antigens.

Below is a table showing how proposed 2017 RVUs compare with current rates for all allergy immunotherapy codes. There are no proposed changes for the allergy testing codes. Again, these numbers are not final yet. Final numbers will be released in November of this year.

Code2016 RVUs2017 Proposed RVUsPercent of Increase
95144 (single dose vial0.350.375.71%
95145 (single venom)0.610.7116.39%
95146 (two venoms)1.101.3018.18%
95147 (three venoms)0.991.3839.39%
95148 (four venoms)1.471.9532.65%
95149 (five venoms)1.982.5729.80%
95165 (multi-dose vial)0.360.372.78%

 

Additional information and a more complete analysis of the entire fee schedule rule will be published by late July or early August.

Advocacy Issue: 
Billing, Coding & Payments