The Medicare fee schedules were published Friday afternoon (all of them at once-Physician, ASC/HOPD and ESRD rules). The ASC and Hospital Outpatient reimbursement continues to increase due to a Medical Economic Index with inflators each year. The Physician office payments and Physician professional fees had cuts related to the way these codes are priced. There was a cut in the conversion factor of 2.8% that impacted all CPT codes in the physician office across all specialties.

The Dialysis Vascular Access Coalition has prepared a spreadsheet showing major codes in the Physician office; ASC and HOPD rates along with the Site of Service (SOS) comparison may be found here

PHYSICIAN OFFICE SETTING
Overall PFS down again, this time between 6-7% for repair and maintenance codes as well as PD catheter implantation codes in part because the conversion factor for MD office went from $33.29 per RVU to $32.35 per RVU. Once again, we expect Congress to soften the MD office cuts but that won't be done until the end of the year during the lame duck session. pAVF creation in the physician office for both devices declined 8%.

AMBULATORY SURGERY CENTER
ASC rates are up between 4-9% for repair and maintenance codes (36901-36909) except for a decrease in Angiogram rates.

Access Creation codes in the ASC were up 4% for surgical creation; pAVF rates were up 11% for the Ellipsys device; down 1% for the Wavelinq device.

PD placement rates were down in the Physician office setting but up 4-6% in the ASC.

HOSPITAL OUTPATIENT DEPT
Rates went up on virtually all codes although professional fees went down due to the physician fee schedule cuts overall.

The continued cuts in the MD office based center continues, with another year of declining reimbursement. ASDIN will continue its advocacy efforts with DVAC and RPA again this year. Angioplasty 36902 is now down 42% from the 2016 rates with Physician office angioplasty paying only 39% of the ASC rate and only 19% of the HOPD rate for the same procedure! (this rate comparison does include the pro fees for the ASC and HOPD rates).

All code payments for next year are available for download on the CMS website.

ASDIN will be hosting a webinar in December for you and your coding/billing team to review the 2025 fee schedule and provide some good tips on documentation and share frequently asked questions. Stay tuned for the date and time for that event.

Terry

Terry F Litchfield, MPA, CPC
ASDIN Advocacy Chair