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    Interventional Cardiology Fares Better Than Many in CMS Final Physician Payment Rule for 2016

    November 05, 2015

    With no threat of severe cuts from the Sustainable Growth Rate (SGR), the Centers for Medicare & Medicaid Services (CMS) released its final rules for 2016 on October 30, 2015. SCAI’s advocacy efforts on behalf of interventional cardiology patients and the specialists that care for them have been well. Fees for the average interventional cardiology procedure increased by 0.7% (see chart). Others did not fare as well. Cardiology as a whole saw no net change in reimbursement. Even worse, some electrophysiology and echocardiography procedures have been targeted for re-evaluation by CMS. Such re-evaluation typically results in lower reimbursement

    As requested by SCAI, CMS has identified most invasive cardiovascular procedures as higher risk “surgical procedures” for the purpose of calculating malpractice RVUs, which increases those payments. CMS has also elevated interventional cardiology from a subcategory of internal medicine to its own specialty, which may result in future increases in malpractice RVUs.

    SCAI secured another victory around transcatheter pulmonary valve implantation (TPVI). SCAI RUC Advisor and Structural Heart Disease Committee Chair Cliff Kavinsky, MD, PhD, FSCAI and SCAI staff were successful in getting American Medical Association’s (AMA) multispecialty Relative-Value Update Committee (RUC) and CMS to assign 25 work value units (WRVU) to the new TPVI CPT code 33477. The robust valuation for this procedure translates to a national average payment of $1,424.04 for TPVI.

    To put the 25.0 WRVU for the new TPVI code in perspective, the value for the percutaneous femoral TAVR code (33361) has a WRVU of 25.13. However, TAVR has a co-surgeon requirement that results in providers being paid 62.5% of the value, supporting an adjusted rate of 13.83 WRVUs for TAVR.

    In other good news, CMS is continuing to review the issue of carving the value of moderate sedation from the codes within CPT that have been tagged as having this work inherent. SCAI's opposition to CMS' proposed "once size fits all" approach has been heard loud and clear. CMS acknowledged receiving comment "that practitioners who furnish services for which there are claims data supporting the inherent nature of moderate sedation should not have to report moderate sedation separately, as they believe they would be faced with administrative burden and costs.”  

    For questions pertaining coding and reimbursement, please contact SCAI Director of Reimbursement and Regulatory Affairs, Dawn R. Gray, at dgray@scai.org.