The Essential RBRVS. A comprehensive listing of RBRVS values for CPT and HCPCS codes

Transcription

1 The ssetial RBRVS comprehesive listig of RBRVS values for CPT ad HCPCS codes

2 Cotets Gettig Started ith The ssetial RBRVS...i troductio... troductio 1 Developmet... troductio 1 Features... troductio 1 RBRVS Highlights... troductio 2 Ho to Use This Book... troductio 5 Geographic Practice Cost dexes: Locality Discussio... troductio 5 Medicare ad RBRVS... troductio 6 Private Sector Payers ad RBRVS... troductio 7 Private Sector ad the Coversio tor... troductio 8 Capitated Cotracts ad RBRVS... troductio 8 Determiig a Gross Coversio tor... troductio 10 Determiig a Frequecy-djusted Coversio tor... troductio 10 Developig a RBRVS-Based Fee Schedule. troductio 12 Productivity alysis Usig RBRVS... troductio 14 Cost/Beefit alysis... troductio 14 Five-Year Revie Process... troductio 16 Medicare Sustaiable Groth Rate (SGR)... troductio 17 RBRVS Termiology... troductio 17 Descriptio of Colums i RBRVS Table... troductio 20 Modifiers... troductio 22 Medicare Coversio tors & GPCs... Coversio tors 1 GPC Tables...Coversio tors 1 Calculatig GPC djusted Reimbursemet Rate...Coversio tors 2 Regioal esthesia Coversio tors...coversio tors 3 esthesia... esthesia i Calculatios of esthesia Values... esthesia ii esthesia Values... esthesia 1 Radiology... Radiology i Radiology Values...Radiology 1 Pathology ad Laboratory...Pathology i Pathology ad Laboratory Values...Pathology 1 Medicie...Medicie i Medicie Values...Medicie 1 valuatio ad Maagemet... /M i valuatio ad Maagemet Values.../M 1 Category...Category i Category Values...Category 1 Category... Category i Category Values...Category 1 HCPCS...HCPCS i HCPCS Values...HCPCS 1 ppedix...ppedix 1 Descriptio of Colums i ppedix...ppedix 1 ppedix B...ppedix B 1 OPPS Cap o the Techical Compoet of Radiology Services...ppedix B OPPS TC Paymet mout...ppedix B 1 Determiig the Loer of the MPFS ad OPPS Paymet Rates for Diagostic Radiology Services...ppedix B 1 Multiple Procedure Reductio...ppedix B 2 Table Layout...ppedix B 3 Diagostic magig Family dicator...ppedix B 3 Procedural dex... dex 1 Surgery... Surgery i Surgery Values...Surgery Optumsight st Quarter Update CPT 2014 merica Medical ssociatio. ll Rights Reserved.

3 Gettig Started ith The ssetial RBRVS This page ill help you avigate the data ithi. For more detailed iformatio about this data or ho to use The ssetial RBRVS please refer to the appropriate pages i the troductio. Withi each sectio of the book you ill also fid detailed iformatio for specific sectios of CPT ad HCPCS codes. f you have additioal questios please cotact Customer Service at Status. Medicare status. For a complete descriptio see page troductio 20. Where CMS has ot assiged a status code the field is blak. Modifier. For a complete descriptio of modifiers as applied to CPT codes see page troductio 22. For a complete descriptio of modifiers applied to HCPCS codes see page HCPCS 1. ility total relative value uit. The sum of the ork practice expese ad malpractice RVUs he the service is performed i a facility settig. The total umber is usually used he calculatig RBRVS-based fees. See page troductio 22. ofacility total relative value uit. The sum of the ork practice expese ad malpractice RVUs he the service is performed i a o-facility settig. The total umber is usually used he calculatig RBRVS-based fees. See page troductio 22. ility practice expese relative value uit. The portio of the total RVU that represets the expese of the service he performed i a facility settig. See page troductio 21. ofacility practice expese relative value uit. The portio of the total RVU that represets the expese of the service he performed i a office or other o-facility settig. See page troductio 21. Work relative value uit. The portio of the total RVU that represets the actual physicia ork ivolved. See page troductio 21. Malpractice (expese) relative value uit. The portio of the total RVU that represets the risk associated ith the service. See page troductio 22. Symbols. Desigate e or chaged codes ad specific CPT guidelies. key appears o the bottom of each page. For a complete descriptio of these symbols see page troductio 20. Global period. The umber of days specified by CMS for hich services directly related to the procedure are icluded ad caot be billed separately. See page troductio 22. Gap. idicates that the relative value assiged as developed by Optumsight. See page troductio 22. OPPS cap. dicates the OPPS cap applies to this code. See page troductio 22 or appedix B Optumsight st Quarter Update i CPT 2014 merica Medical ssociatio. ll Rights Reserved.

4 Surgery a Code M S Descriptio Keratomileusis Keratophakia pikeratoplasty Keratoprosthesis Radial keratotomy Coreal relaxig icisio for correctio of surgically iduced astigmatism Coreal edge resectio for correctio of surgically iduced astigmatism Placemet of amiotic membrae o the ocular surface for oud healig; self-retaiig sigle layer sutured Ocular surface recostructio; amiotic membrae trasplatatio multiple layers limbal stem cell allograft (eg cadaveric or livig door) limbal cojuctival autograft (icludes obtaiig graft) Paracetesis of aterior chamber of eye (separate procedure); ith diagostic aspiratio of aqueous ith therapeutic release of aqueous ith removal of vitreous ad/or discissio of aterior hyaloid membrae ith or ithout air ijectio ith removal of blood ith or ithout irrigatio ad/or air ijectio Goiotomy Trabeculotomy ab extero Trabeculoplasty by laser surgery 1 or more sessios (defied treatmet series) Severig adhesios of aterior segmet laser techique (separate procedure) Severig adhesios of aterior segmet of eye icisioal techique (ith or ithout ijectio of air or liquid) (separate procedure); goiosyechiae aterior syechiae except goiosyechiae posterior syechiae coreovitreal adhesios Removal of epithelial dogroth aterior chamber of eye Removal of implated material aterior segmet of eye Removal of blood clot aterior segmet of eye jectio aterior chamber of eye (separate procedure); air or liquid medicatio xcisio of lesio sclera Fistulizatio of sclera for glaucoma; trephiatio ith iridectomy thermocauterizatio ith iridectomy sclerectomy ith puch or scissors ith iridectomy iridecleisis or iridotasis trabeculectomy ab extero i absece of previous surgery Work Value Malpractice o- P P o Global Gap RVU ot developed by CMS. Gap value developed by Optumsight Optumsight CPT 2014 merica Medical ssociatio. ll Rights Reserved st Quarter Update Chage for this update. Surgery 179

5 Medicie Medicie Values s s + + Code M S X X R Descriptio mmue globuli (g) huma for itramuscular use mmue globuli (gv) huma for itraveous use mmue globuli (SCg) huma for use i subcutaeous ifusios 100 mg each Botulium atitoxi equie ay route Botulism immue globuli huma for itraveous use Cytomegalovirus immue globuli (CMV-gV) huma for itraveous use Diphtheria atitoxi equie ay route Hepatitis B immue globuli (HBg) huma for itramuscular use Rabies immue globuli (Rg) huma for itramuscular ad/or subcutaeous use Rabies immue globuli heat-treated (Rg-HT) huma for itramuscular ad/or subcutaeous use Respiratory sycytial virus moocloal atibody recombiat for itramuscular use 50 mg each Rho(D) immue globuli (Rhg) huma full-dose for itramuscular use Rho(D) immue globuli (Rhg) huma mii-dose for itramuscular use Rho(D) immue globuli (RhgV) huma for itraveous use Tetaus immue globuli (Tg) huma for itramuscular use Vacciia immue globuli huma for itramuscular use Varicella-zoster immue globuli huma for itramuscular use Ulisted immue globuli mmuizatio admiistratio through 18 years of age via ay route of admiistratio ith couselig by physicia or other qualified health care professioal; first or oly compoet of each vaccie or toxoid admiistered each additioal vaccie or toxoid compoet admiistered (List separately i additio to code for primary procedure) mmuizatio admiistratio (icludes percutaeous itradermal subcutaeous or itramuscular ijectios); 1 vaccie (sigle or combiatio vaccie/toxoid) each additioal vaccie (sigle or combiatio vaccie/toxoid) (List separately i additio to code for primary procedure) mmuizatio admiistratio by itraasal or oral route; 1 vaccie (sigle or combiatio vaccie/toxoid) Work Value Malpractice o- P P o Global Gap OPPS RVU ot developed by CMS. Gap value developed by Optumsight. Chage for this update Optumsight st Quarter Update CPT 2014 merica Medical ssociatio. ll Rights Reserved. Medicie 1

6 HCPCS Code G0250 G0251 G0252 G0255 G0257 G0259 G0260 G0268 G0269 G0270 G0271 G0275 G0278 M 26 TC 26 TC S Descriptio R Physicia revie iterpretatio ad patiet maagemet of home R testig for patiet ith either mechaical heart valve(s) chroic atrial fibrillatio or veous thromboembolism ho meets Medicare coverage criteria; testig ot occurrig more frequetly tha oce a eek; billig uits of service iclude 4 tests Liear accelerator based stereotactic radiosurgery delivery icludig collimator chages ad custom pluggig fractioated treatmet all lesios per sessio maximum 5 sessios per course of treatmet PT imagig full ad partial-rig PT scaers oly for iitial diagosis of breast cacer ad/or surgical plaig for breast cacer (e.g. iitial stagig of axillary lymph odes) B Curret perceptio threshold/sesory erve coductio test (SCT) per limb ay erve Uscheduled or emergecy dialysis treatmet for a SRD patiet i a hospital outpatiet departmet that is ot certified as a SRD facility jectio procedure for sacroiliac joit; arthrography jectio procedure for sacroiliac joit; provisio of aesthetic steroid ad/or other therapeutic aget ith or ithout arthrography Removal of impacted cerume (oe or both ears) by physicia o same date of service as audiologic fuctio testig Placemet of occlusive device ito either a veous or arterial access site postsurgical or itervetioal procedure (e.g. agioseal plug vascular plug) Medical utritio therapy; reassessmet ad subsequet itervetio(s) folloig secod referral i same year for chage i diagosis medical coditio or treatmet regime (icludig additioal hours eeded for real disease) idividual face-to-face ith the patiet each 15 miutes Medical utritio therapy reassessmet ad subsequet itervetio(s) folloig secod referral i same year for chage i diagosis medical coditio or treatmet regime (icludig additioal hours eeded for real disease) group (2 or more idividuals) each 30 miutes Real agiography oselective oe or both kideys performed at the same time as cardiac catheterizatio ad/or coroary agiography icludes positioig or placemet of ay catheter i the abdomial aorta at or ear the origis (ostia) of the real arteries ijectio of dye flush aortogram productio of permaet images ad radiologic supervisio ad iterpretatio (List separately i additio to primary procedure) liac ad/or femoral artery agiography oselective bilateral or ipsilateral to catheter isertio performed at the same time as cardiac catheterizatio ad/or coroary agiography icludes positioig or placemet of the catheter i the distal aorta or ipsilateral femoral or iliac artery ijectio of dye productio of permaet images ad radiologic supervisio ad iterpretatio (List separately i additio to primary procedure) Work Value o- P P Malpractice o Global Gap OPPS 000 RVU ot developed by CMS. Gap value developed by Optumsight Optumsight CPT 2014 merica Medical ssociatio. ll Rights Reserved. F Rouded gap value for a RVU less tha st Quarter Update Chage for this update. HCPCS 75