2015 Fee Schedule Lacks Payment Code Details, AAFP Tells CMS

December 17, 2014 10:04 pm News Staff

Noting that the 2015 Medicare physician fee schedule lacks details about several new codes that affect primary care, the AAFP recently sent CMS a letter(3 page PDF) seeking more information about the codes.

[Doctor listening to elderly man's chest]

The agency typically publishes relative value units (RVUs) for payment codes even if Medicare does not pay for the services. But in the final rule for 2015, CMS did not include the RVUs for some of these codes.

"CMS established this precedent when it published RVUs for the preventive medicine services codes (99381-99397)," the letter notes.

In the past two years, CMS has recognized several codes that are used by primary care physicians, such as the transitional care management codes for which the agency began paying in 2013. Most recently, the agency adopted the chronic care management services code 99490, which will be eligible for billing in 2015. The code may be used for patients with two or more conditions expected to last at least 12 months or until the death of the patient.

Although Medicare will not recognize a separate code -- 99487 -- that describes complex chronic care management services in 2015, the AAFP notes in its letter that other insurers could recognize the code and urges CMS to publish the RVUs associated with it.

"CMS should publish the practice expense RVUs for this code, as it has in the past," says the letter.

Regarding advance care planning codes 99497 and 99498, Medicare does not currently recognize or reimburse for these codes and says another code should be used for reporting and paying for such care. CMS said it will consider official recognition of the two codes, but the agency did not specify what issues will need to be reviewed to reach a determination.

In the letter, the AAFP asks CMS to explain what code it is already using to pay for these services and the issues under consideration to approve payment for the code. Some private insurers may already be paying for advance care planning, the letter notes.

Instead of billing for these services through use of another code, such as an existing evaluation and management code, the AAFP states it would be helpful to primary care practices if CMS would officially recognize the new codes.

CMS also did not include an RVU for fluoride varnish application in the Medicare fee schedule. However, Medicaid, which insures a high percentage of children, may cover the service, says the AAFP, and urges CMS to publish the related RVUs for it.