The Centers for Medicare and Medicaid Services has proposed rate cuts for a large number of TC pathology codes in its proposal for the agency’s 2017 Medicare Physician Fee Schedule, a move the agency has justified primarily as a reflection of the reduced cost of supplies for these procedures.
The most significant proposed cuts would affect TC rates for 17 codes, with the most notable being a 15 percent reduction for 88305-TC ($29.34) that CMS has attributed to the decreased cost of utilizing eosin stain supplies rather than eosin solution. The other codes negatively affected by this adjustment include 88302, 88304, 88307, 88309, 88323, 88325, 88364, 88365, 88366, 88367, 88368, 88369, 88373, 88374, 88377 and G0416.
The only other major reduction is a 19 percent drop for 88184, 88185 and 88189, which pertain to flow cytometry.
Fortunately, the rates for professional components will remain largely unchanged.
Although there were very few rate hikes proposed, there were at least some notable concessions made. The most significant hike would boost global reimbursement for 88361 by 4 percent ($155.98), while also upping the code’s technical component by 7 percent ($94.80) and its professional portion by 1 percent ($61.18). Additionally, the professional portion of the G0416 prostate biopsy would see a 17 percent boost ($184.96)
Check out the chart below for a breakdown of the major proposed changes for several key pathology codes. Keep in mind that the conversion factor for 2016 is 35.8043, while the proposed factor for 2017 is 35.7751.
Comparing these rate adjustments against your lab’s current volume will be essential in determining how your revenue stands to be impacted, assuming the proposed rates remain relatively static in the finalized Medicare fee schedule that is expected to be released in October.
CMS is accepting public comment on its proposed fee schedule through Sept. 6. The new rates will then go into effect on Jan. 1, 2017.
|CPT Code||Description||Proposed 2017||Current 2016||Percent Change|
|88112-Global||Cytopath cell enhance tech||68.33||72.32||-6%|
|88112-26||Cytopath cell enhance tech||28.98||29.00||0%|
|88112-TC||Cytopath cell enhance tech||39.35||43.32||-9%|
|88184-TC only||Flow cytometry/1st marker||61.53||76.26||-19%|
|88185-TC only||Flow cytometry/each additional marker||37.56||46.55||-19%|
|88189-TC only||Flow cytometry, read 16+||92.30||114.22||-19%|
|88305-Global||Tissue exam by pathologist||69.05||74.11||-7%|
|88305-26||Tissue exam by pathologist||39.71||39.74||0%|
|88305-TC||Tissue exam by pathologist||29.34||34.37||-15%|
|88307-Global||Level V, tissue exam by pathologist||269.03||312.21||-14%|
|88307-26||Level V, tissue exam by pathologist||87.65||87.36||0%|
|88307-TC||Level V, tissue exam by pathologist||181.38||224.85||-19%|
|88312-Global||Special stains, group 1||98.74||98.82||0%|
|88312-26||Special stains, group 1||28.26||28.29||0%|
|88312-TC||Special stains, group 1||70.48||70.53||0%|
|88313-Global||Special stains; group 2||70.12||69.10||1%|
|88313-26||Special stains; group 2||12.52||12.53||0%|
|88313-TC||Special stains; group 2||57.60||56.57||2%|
|88341-Global||Immunohistochemistry (Additonal stain)||90.15||90.23||0%|
|88341-26||Immunohistochemistry (Additonal stain)||28.26||27.93||1%|
|88341-TC||Immunohistochemistry (Additonal stain)||61.89||62.30||-1%|
|88342-Global||Immunohistochemistry (1st stain)||107.68||107.41||0%|
|88342-26||Immunohistochemistry (1st stain)||37.21||37.24||0%|
|88342-TC||Immunohistochemistry (1st stain)||70.48||70.18||0%|