Anesthesia Conversion Factor (CF) rose 0.27 percent to $22.27 from $22.19 in 2018
The Centers for Medicare and Medicaid Services (CMS) has published the 2019 Physician Fee Schedule (PFS) final rule detailing, among other things, how anesthesia practitioners will be paid in the coming year and how their participation in Year 3 of the Quality Payment Program (QPP) could impact their payment in 2021.
The national anesthesia conversion factor (CF) rose 0.27 percent to $22.27 from $22.19 in 2018, reflecting anesthesia-specific resource costs related to practice expenses and malpractice insurance. This CF represents the national average. The table here shows the 2018 and 2019 anesthesia CFs by location.*
The non-anesthesia CF also rose slightly from $35.99 to $36.04, representing a 0.25 percent adjustment as mandated by the Bipartisan Budget Act of 2018 as well as a negative 0.14 percent adjustment in keeping with the law’s budget neutrality requirements. Anesthesiologists would use this CF to bill for flat fee services, such as the use of ultrasound guidance and nerve block placement.
As proposed, the work relative value unit (RVU) (one of the three components used to determine fees) for CPT code 95970 (Electronic analysis of implanted neurostimulator pulse generator/transmitter) was reduced from 0.45 to 0.35 for 2019.
Some changes in documentation requirements for E&M services designed to ease administrative burden for clinicians will be implemented in 2019. We are analyzing these changes and will discuss them in a future eAlert. We will also discuss the implications for anesthesia and pain management providers of the significant expansion of payment for telehealth services that became policy with the final rule.
CMS will cancel major bundled payment initiatives
CMS has proposed canceling the cardiac and expanded joint replacement bundled payment models.
The rule, which was sent to the Office of Management and Budget last week, would cancel the mandatory bundled payment programs for heart attacks and bypass surgeries as well as expansion of the existing Comprehensive Care for Joint Replacement model to include surgical treatments for hip and femur fractures. Those bundled payment initiatives have already been delayed twice. They’re currently slated to take effect Jan. 1, 2018.
Physicians would have the opportunity to earn a 5 percent bonus for participating in the cardiac bundles or the expanded CJR model, as the initiatives qualify as Advanced Alternative Payment Models under the Medicare Access and CHIP Reauthorization Act’s Quality Payment Program. Once finalized, the CMS rule would eliminate the bonus opportunity for physicians.
