Physician fee schedule rate change delayed

The Centers for Medicare and Medicaid Services (CMS) released the final rule for its physician fee schedule November 1 and stated that providers would see an across-the-board reduction of 27.4% for services in 2012, but much is still unclear about this change.

Key Points

Q: Is it true that the rate change for the physician fee schedule is going to be reduced by more than 29%?

On December 23, however, President Obama signed a bill into law that prevents the cut for 60 days. Members of the Senate and House are negotiating a longer-term extension.

The following are additional important topics addressed in the PFS final rule.

Although this is the final rule, Congress has an opportunity to change the law, and historically, Congress has exercised its right to change the final rule well into the following calendar year. There is additional pressure, given President Obama's budget calls for avoiding these cuts and finding a permanent solution, and many national organizations have expressed concern about the SGR and its continuing threat to both physicians and patients. So we will be watching this front closely as the drama unfolds and informing you of any progress.

Also, we'll have more information about the personalized prevention plan services of the AWV and covered telehealth services in future columns.


Q: We are in the process of updating our charge sheet, including modifiers. Can you give us the updated Clinical Laboratory Improvement Amendments (CLIA)-waived tests?

Even though these tests were approved during the 2011 year, Medicare's notification was published October 21, and these codes became effective January 1.

These current procedural terminology codes must have the modifier QW appended to be recognized as a waived test.

The CLIA regulations require a facility to be certified for each test performed. To ensure that Medicare and Medicaid only pay for laboratory tests categorized as waived complexity under CLIA in facilities with a CLIA certificate of waiver, laboratory claims are currently edited at the CLIA certificate level.

The author is a medical consultant based in Indianapolis, Indiana. Do you have a primary care-related coding question you would like to have our experts answer in this column? Send it to

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