'09 Fee Schedule has Positive Impact on Pathology

On Thursday, October 30, the Centers for Medicare and Medicaid Services (CMS) released the 2009 Physician Fee Schedule Final Rule which included a 1.1% increase in the Conversion Factor that was mandated by Congress in July.  The 1.1% increase to the Conversion Factor combined with the change in the way the budget neutrality adjustment is applied this year (spreading it across all procedures instead of applying it only to professional component, as they have the last two years) appears to have resulted in some fairly significant increases for BOTH the independent labs billing Global and TC-only services as well as the physician practices billing PC-only.

Specifically, the 88305-26 national rate (unadjusted for locality) will increase by 2.7%, from $36.18 to $37.15; and the 88304-26 will increase 5.3%, from $10.28 to $10.82. These increases of course will vary from client to client based on the locality adjustment.  For example, in South Carolina, where the adjustment factors for Practice Expense and Malpractice Expense both increased, the increases for pathologists in South Carolina appear to run about a full percentage point higher than the increases in the national rates. 

CPT

2008 MPFS

2009 MPFS

Change

2008 SC MPFS

2009 SC MPFS

SC Change

88304

$ 61.32

$ 61.31

0.0%

$ 55.01

$ 55.80

1.4%

88304-26

$ 10.28

$ 10.82

5.3%

$ 9.77

$ 10.38

6.2%

88305

$ 102.83

$ 103.87

1.0%

$ 93.25

$ 95.49

2.4%

88305-26

$ 36.18

$ 37.15

2.7%

$ 34.43

$ 35.70

3.7%

88307-26

$ 77.70

$ 78.99

1.3%

$ 73.96

$ 75.96

2.7%

88312-26

$ 25.90

$ 26.33

1.7%

$ 24.71

$ 25.35

2.6%

88313-26

$ 11.43

$ 11.54

1.0%

$ 10.87

$ 11.10

2.1%

88342

$ 95.98

$ 98.10

2.2%

$ 87.87

$ 90.93

3.5%

88342-26

$ 40.75

$ 41.12

0.9%

$ 38.88

$ 39.64

1.9%

88185

$ 41.51

$ 46.53

12.1%

$ 36.73

$ 41.82

13.9%

PSA affiliated practices are encouraged to contact their billing department for additional information.  PSA will continue to keep affiliated practices updated on news and regulations impacting the pathology industry.