CMS PROPOSED RULE (JULY '09)
On July 13, 2009, the Centers for Medicare & Medicaid Services (CMS) published in the Federal Register its proposed Payment Policies under the Physician Fee Schedule for Calendar Year (CY) 2010. These policy changes, if finalized, would have significantly impacted reimbursement levels for radiation therapy (and many other services performed in a physician's office). Of note were three proposed cuts in reimbursement for radiation therapy:
Proposed Cut #1: CMS would assume that all equipment valued over $1 million is utilized 90 percent of the time, versus the current 50 percent utilization assumption. This would result in a 44 percent decrease in reimbursement.
Proposed Cut #2: CMS would reduce or eliminate the malpractice relative value units (RVUs) from the fee schedule amounts for radiation therapy and certain other services. This would result in a 0.9 percent decrease in reimbursement.
Proposed Cut #3: CMS would implement a sustainable growth rate (SGR) adjustment of -21.5 percent for CY 2010.
Overall impact: When combined with the changes in practice expense relative value units scheduled according to the four year Medicare Physician Fee Schedule implementation schedule, these proposals, if finalized, would have resulted in a decrease in the Medicare reimbursement rate for IMRT (CPT Code 77418) of over 60 percent, depending on the location where the service is furnished.
To review CMS' proposed changes in the Federal Register,
click here.
To learn more about CMS' final rule for the 2010 Medicare Physician Fee Schedule,
click here.
"With African Americans having the highest death rate and shortest survival of any racial and ethnic group in the United States for most cancers, we're deeply concerned about a proposed government policy that would create a significant barrier to cancer treatment."
Congressional Black Caucus Members' response to CMS
