January 2005 | Vol. 23, No. 1

Happenings in Government Relations

By Bill Schroedter, BS RVT FSVU
Chair, Government Relations Committee

2005 Physician Fee Schedule

It was a Merry Christmas and will be a Happy 2005 for Vascular Testing! The 2005 Physician Fee Schedule has been published by the Centers for Medicare and Medicaid Services (CMS) and specifically referenced comments submitted by the Society for Vascular Ultrasound. SVU requested that CMS incorporate the refinements for the other ancillary equipment present in the vascular ultrasound room as opposed to a typical “general” ultrasound room (which by the way was also increased). As a result, vascular testing posted significant gains due to these refined practice expense inputs that were in fact, supplied by many of you – SVU members. Thanks! In addition, the increase in practice expense Relative Value Updates (RVUs) for diagnostic testing facilities is also attributable for the increase in payment for 93880 and 93925 due to the substitution of a vascular ultrasound room for a general ultrasound room in the equipment resources.

A new CPT code (G-0365) was proposed as a mechanism for the vascular surgeon to perform pre-op mapping prior to creation of an access graft.  CMS differentiated it from use of 93971, which is the duplex scan evaluating access patency.  Based upon the comments SVU submitted, CMS has agreed that other clinicians, besides the operating surgeon, may use the code. RVUs will be mapped to 93990 for work (.25), malpractice (.26), and practice expense (3.99 for both facility and nonfacility). This is somewhat less than SVU recommended in our comment letter. SVU also tried to convince them of the need for a bilateral study that was not approved. The Code is limited for use in patients without prior hemodialysis access graft or fistula and is limited to twice a year.

See Your Local Carrier Website for Local Reimbursement Values and Specifics Regarding the New CPT Code G0365.

While reimbursement news for vascular testing is good for 2005, the near future looks extremely dismal. The increase for 2005 will be followed by proposed 5% cuts annually from 2006 through 2013, for a total of 31% decrease in the Conversion Factor for all providers due to several problems with the Sustainable Growth Rate (SGR), concomitant with a real and unavoidable 19% increase in direct Practice Expense costs. The AMA met with the CMS Administrator and has been unable to arrive at a solution for 2006. Understand, this decrease is dictated by Medicare law and will take Congressional action to avoid. Unfortunately, the environment in D.C. is going to be extremely difficult for physicians given the huge deficits, the War and other spending priorities.

Of particular note, a review of work values for CPT codes will begin in 2005 and this process can have a lasting effect on our reimbursement. We have seen from experience that specialties exist that believe significant decreases in practice expense for noninvasive vascular testing are warranted. If asked to fill out a survey by SVU or other allied societies (SVS, SDMS), please take the time to do so as our profession’s future quite possibly depends upon it.

National Aneurysm Alliance

The SVU is a member of the National Aneurysm Alliance (NAA), which has been attempting to persuade Congress to create an aneurysm screening benefit to the Medicare Program. Activities on this have dropped off dramatically as expected given the attention of the recent national election and the end of the 108th Congress. However, there will be a flurry of action when the 109th Congress convenes in early January 2005. The best news for moving the AAA screening bill(s) forward came from the U.S. Preventative Services Task Force (USPSTF), which is expected to recommend that screening for AAA has significant, albeit limited benefit.

2005 SVU Current Issues Conference

The 2005 SVU Current Issues Conference, with the latest information on various regulatory and legislative issues, is scheduled for Nov. 4-5, 2005 in Crystal City, VA, near Reagan National Airport. This comprehensive government relations conference, which was last held in Nov. 2003, is now held every other year. If you are involved in Medicare billing and reimbursement for your vascular lab, make plans now to attend this important conference. Watch the SVU website for details this spring.