CMS releases final 2019 fee schedules for physicians, HOPDs, and ASCs: Mixed news for interventional pain management physicians

The Centers for Medicare and Medicaid Services (CMS) released the final 2019 Medicare physician fee schedule (PFS), ASC & HOPD rules, addressing Medicare payment rates and policy provisions for 2019.

CY 2019 Physician Fee Schedule Final Rule

ASC: 2019 Final Rule

HOPD: 2019 Final Rule

The rule is a mix of achievements and some failings for interventional pain physicians:

1.Physicians will see a 0.1% conversion factor payment increase on January 1, 2019. The issues impacting interventional pain physicians with EM documentation guidelines and IPM payment rates are as follows:

  • Physicians will no longer be required to re-record elements of history and physical exam when there is evidence that the information has been reviewed and updated. In addition,
  • Physicians must only document that they reviewed and verified information regarding chief complaint and history that is already recorded by ancillary staff or the patient.

However, these changes apply only for Medicare patients. As of now, we do not know if Medicaid and all other payers will follow these rules or guidance.

2. CMS is not moving forward on a proposal to reduce payment for office visits when performed on the same day as another service.

3. CMS is also not moving forward for 2019 and instead postponing to 2021 the proposed single payment rate for Level 2 through Level 5 office visits and to reduce documentation requirement for this collapsed payment of that of a Level 2 CPT visit code.

4. IPM procedural payment changes proposed are retained in the final rule with minor additional increases of 1% to 3% for some procedures. The proposed rule itself had a significant increase for CPT 63650 (from $1,353.72 to $1,613.43) for percutaneous lead placement in an office setting which actually has been increased further to $1,657.08. The IPM payment schedule is as follows:

Click here to read the 2019 PHYSICIAN FEE SCHEDULE FINAL RULE

However, CMS has not increased the reimbursement peripheral nerve blocks and neurolytic blocks. There are also reductions for interspinous prosthesis.

ASC & HOPD Payment Rates:

Good News:

We are seeing increases of:

  • 12.5% from 2018 for Percutaneous adhesiolysis procedure, transforaminal epidural injections, facet joint injections, sympathetic blocks, celiac plexus, intercostal nerve and pudendal nerve neurolysis from $350.20 to $393.80.
  • 8.9% from 2018 for Cervical and lumbar interlaminar epidural injections and Sacroiliac joint injections from $283.10 to $308.32.

Proposed payment rates are retained in the final rule with minor decreases of 1% to 2% for some procedures

CMS did not consider our request to increase the reimbursement for peripheral nerve blocks and neurolytic blocks, epidural injections (CPT codes 62321 and 62323) and percutaneous adhesiolysis (CPT 62264).

For ASC FINAL payment rates click here.

For HOPD FINAL payment rates click here.