CMS Projects FPs Will Receive 2 Percent Increase in Allowed Charges for 2011

January 11, 2011 04:55 pm News Staff

According to a newly released Emergency Update to the CY 2011 Medicare Physician Fee Schedule (MPFS) Database(www.cms.gov) that enumerates CMS' final 2011 Medicare conversion factor, the average payment rate for CPT code 99213 -- a code commonly used by FPs -- will increase this year even though the numeric value of the conversion factor has been reduced.

As a result of these and other factors, CMS projects that family physicians will see an overall 2 percent increase in their Medicare allowed charges in 2011.

Despite the reduction in the Medicare conversion factor, the payment rate for many CPT codes, including 99213, will increase in 2011 because the relative value units, or RVUs, for the services are increasing. For example, total RVUs for CPT 99213 climbed to 2.03 in 2011 from 1.81 in 2010, resulting in an increase in the average payment for code 99213 from $66.74 to $68.97, or about 3.3 percent.

Conversion factor and RVU changes will vary depending on the code in question and the Medicare locality where services are performed because other factors will impact payment rates, including updated geographic practice cost indices(www.gao.gov). This year also marks the second year of the transition to new practice expense relative values.

CMS issued the update after Congress passed the Medicare and Medicaid Extenders Act of 2010, which blocked a steep reduction in Medicare physician payment called for under the sustainable growth rate formula and provided a yearlong payment patch.


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