On Friday, July 6 the Centers for Medicare & Medicaid Services (CMS) published a proposed rule recommending changes to payment for the Medicare program for calendar year (CY) 2013. Recommendations made in the proposed rule will be reviewed and, based on comment from the public, may be finalized in the final rule which will be published in November.
Proposed Rule Highlights: CMS published a news bulletin highlighting some of the key points of the proposed rule. The rule recommends an increase of payments to family physicians by approximately 7 percent. Other practitioners providing primary care services are recommended to receive an increase in payments between 3 and 5 percent. However, the bulletin also highlights that as a result of the Sustainable Growth Rate (SGR) methodology used to calculate the conversion factor, overall payments are expect to be cut by 27 percent in 2013. While Congress has taken steps to prevent such significant cuts in previous years, CMS is required by law to propose the cut in their proposed and final rules until Congress takes action.
Changes to Sleep RVUs: The proposed rule also describes changes to payment for sleep services. The rule recommends a decrease in practice expense (PE) relative value units (RVUs) for most sleep services in 2013. As a result, overall payment for sleep services is recommended to decrease in most cases. However, for the unattended sleep testing codes 95800 and 95801, practice expense, and therefore overall payment, is expected to increase. The rule recommends that physician work and physician liability insurance (PLI) RVUs for all sleep services remain unchanged from the 2012 rates. A summary chart comparing 2012 RVUs and proposed 2013 RVUs is included for your information below.
Comparison: 2012 RVUs to 2013 Proposed RVUs for Sleep Services
|
CPT |
Description |
2012 Work RVU |
2013 Work RVU |
2012 PE RVU |
2013 PE RVU |
2012 PLI RVU |
2013 PLI RVU |
2012 Total RVU |
2013 Total RVU |
change 2012 to 2013 |
|
95800 |
Sleep study unattended |
1.05 |
1.05 |
3.63 |
4.13 |
0.05 |
0.05 |
4.73 |
5.23 |
10% |
|
95801 |
Sleep study unattended w/analysis |
1.00 |
1.00 |
1.49 |
1.67 |
0.05 |
0.05 |
2.54 |
2.72 |
7% |
|
95803 |
Actigraphy testing |
0.90 |
0.90 |
3.91 |
3.41 |
0.05 |
0.05 |
4.86 |
4.36 |
-11% |
|
95805 |
Multiple sleep latency test |
1.20 |
1.20 |
10.99 |
10.7 |
0.08 |
0.08 |
12.27 |
11.98 |
-2% |
|
95806 |
Sleep study unattended w/ resp efft |
1.25 |
1.25 |
4.07 |
3.93 |
0.08 |
0.08 |
5.40 |
5.26 |
-3% |
|
95807 |
Sleep study attended |
1.28 |
1.28 |
13.21 |
12.7 |
0.15 |
0.15 |
14.64 |
14.13 |
-4% |
|
95808 |
Polysomnography 1-3 |
1.74 |
1.74 |
17.82 |
16.39 |
0.17 |
0.17 |
19.73 |
18.30 |
-8% |
|
95810 |
Polysomnography 4 or more |
2.50 |
2.50 |
16.76 |
15.47 |
0.21 |
0.21 |
19.47 |
18.18 |
-7% |
|
95811 |
Polysomnography w/cpap |
2.60 |
2.60 |
17.93 |
16.24 |
0.23 |
0.23 |
20.76 |
19.07 |
-9% |
Pediatric Sleep Codes: In a previous Weekly Update article, the AASM announced that the CPT approved the creation of two new codes for pediatric polysomnography. The new pediatric polysomnography codes are not included in the CY 2013 proposed rule because they have not yet been published in CPT. The codes will be included in the 2013 CPT codebook, which will be published in September 2012. CMS will assign a value to these codes in the CY 2013 Physician Fee Schedule final rule in November 2012.
The AASM will provide members with additional analysis of the proposed rule in the coming weeks.
