September 2007 | Vol. 25, No. 9

SVU Submits Comments to CMS on the 2008 Physician Fee Schedule Proposed Rule

CMS released its proposed changes to the 2008 Medicare Physician Fee Schedule (PFS) on July 2, 2007. This includes a proposed 9.9% reduction in across-the-board for PFS payments, more restrictive IDTF regulations, and other provisions.

In response to CMS transmittal 1385-P “Proposed Revisions to Payment Policies under the Physician Fee Schedule,” the SVU, with assistance from Sidley Austin, on August 27th submitted its official comment letter on the Proposed Rule to CMS and a request for consideration. SVU is specifically asking CMS for consideration in the following areas:

1. Because the DRA caps only apply to imaging services and TCD is not properly understood as an imaging service (either because no imaging is used or any use of imaging is merely ancillary to a non-imaging service), TCD must be excluded from the DRA caps.
2. Because the DRA caps are distorted by known flaws in the way the hospital outpatient costs are allocated, CMS must make adjustment to the application of the caps to prevent them from improperly reducing payments for physician fee schedule services.

The first point is aimed at removing five TCD codes from the DRA imaging cap, much like the other physiologic (non-image producing) codes were removed by CMS from the DRA based upon SVU and other comments following the enactment of the DRA. This was a rare DRA implementation win, which retained millions of dollars in reimbursement for ultrasound providers, and we hope to build on it with the elimination of these five TCD codes.

You may remember the SVU and American Society of Neuroimaging (ASN) surveyed our combined membership in June of this year regarding TCD practices. The study established that over 70% of TCD does not involve any use of imaging at all. We strongly feel these TCD codes should be excluded from the DRA caps. The results of the recent TCD Survey are available on the Members’ Only page of the SVU website.

With respect to the second point, SVU is asking for CMS to again look at the way the DRA caps are set based on how costs are allocated in the HOPD payment methodology. Similar to our comments to CMS last August following the five-year review of work RVUs in the PFS, SVU continues to advocate for more accurate and effective methods of calculating costs (and therefore reimbursement) in the hospital outpatient setting.

A link to the 8/27/07 SVU comment letter to CMS on the CY2008 Physician Fee Schedule Proposed Rule is under What’s New on the website home page (www.svunet.org).

On August 31, the American Society of Neuroimaging (ASN), Minneapolis, MN, submitted a comment letter to CMS in support of SVU's comment letter to CMS on the 2008 PFS Proposed Rule. ASN President Camilo Gomez, MD, stated in the ASN comment letter, "We entirely support the SVU request that the Current Procedural Terminology ("CPT") codes for transcranial Doppler ("TCD") have to be removed from the list of codes to the HOPD cap because TCD does not meet the statutory definition of "imaging."