Special Update: CMS Revises Sleep Medicine CPT Code

• Information on CMS Revisions to Sleep Medicine Codes
• AASM Action
• CPT Codes and the Future of Sleep Medicine

Information on CMS Revisions to Sleep Medicine Codes

The Centers for Medicare & Medicaid Services (CMS) has released a revision to the 2011 Physician Fee Schedule that adjusts calculations of the Medicare payment rates. The revision includes adjustments to the conversion factor and fees for services, including sleep medicine codes.

The revised final 2011 conversion factor is $33.9764. Previously, the published conversion factor was $36.8729. CMS has notified all Medicare carriers of the change to the conversion factor, and all 2011 claims are expected to be paid on time and at the correct rates with no adjustments or claims holds.

Additionally, the revised final rule includes a reweighing of the physician work, practice expense (PE), and professional liability insurance (PLI) components of the relative value scale; sleep medicine CPT codes are included.

The following table details revised payment information for sleep codes 95800-95811. This table reflects revised RVUs applicable starting immediately. The conversion factor used to calculate the payment information in this table is $33.9764, which reflects the revised conversion factor. Please note this table reflects national payment. The work and geographic adjustment floor – or local payment – was revised in the Medicare and Medicaid Extenders Act of 2011. Page 10 of the Act has a table that details local values for physician work, PE and PLI.

Updated CY 2011 MPFS Geographic Practice Cost Index

2011 National RVU and Payment Information Based on New Fee Schedule and with

Conversion Factor Decrease

*Conversion Factor = $33.9764

Code     Physician Work RVU   Practice Expense (PE) RVU   PLI RVU  Total RVU (Work + PE + PLI)  Payment (Work +PE + PLI)
95800            1.05                               4.95                                       0.05                     6.05                                           $205.56
95801                  1                                 1.8                                       0.05                     2.85                                             $96.83
95803              0.9                               3.83                                       0.05                     4.78                                            $162.41
95805              1.2                               10.8                                       0.08                   12.08                                            $410.43
95806            1.25                               4.03                                       0.08                     5.36                                            $182.11
95807            1.28                               12.4                                       0.15                   13.83                                            $469.89
95808            1.74                             17.21                                       0.17                   19.12                                            $649.63
95810              2.5                             17.72                                       0.21                   20.43                                            $694.14
95811              2.6                             19.22                                       0.23                   22.05                                            $749.18

AASM Action
The AASM is committed to protecting the professional livelihood of its members, safeguarding the sleep medicine field and ensuring access to quality care for sleep patients. To this end, the American Academy of Sleep Medicine (AASM) is sending a letter to the American Medical Association (AMA) that outlines concern with the Specialty Society Relative Value Scale Update Committee (RUC) and the process it employs for making RVU recommendations to CMS and also requests a meeting with the AMA’s President to discuss this matter.

CPT Codes and the Future of Sleep Medicine
The AASM is taking a strategic approach to sleep medicine CPT codes, and the examination of new codes is a major area of address for the Future of Sleep Medicine Task Force. The Future of Sleep Medicine Tools Workgroup is evaluating current and new technologies to determine the feasibility of new codes for sleep medicine, and recommendations will be made at the next meeting in February.

The AASM will keep members abreast of any additional information related to sleep medicine CPT codes as it becomes available.

2011-01-07T00:00:00+00:00 January 7th, 2011|Clinical Resources, Professional Development|