What's new...

For a successful Ambulatory
Surgery Center and a more efficient
and productive clinical practice

What's new ...

NEWS IN PAIN PRACTICE MANAGEMENT 2002

The Health Care Financing Administration

New Name: Centers for Medicare & Medicaid Services (CMS)

New physician specialty code for Pain Management

	The new code is “72”
	Physicians may choose both a primary specialty, and a secondary specialty.
	No limitations on ability to practice or to use particular codes should come from any change you make between primary and secondary specialties.
	File a new 855 Form to change your designation with Medicare

New Medicare Provider Forms

As of November 1, 2001, the State agencies will no longer distribute Forms HCFA-855 or CMS-855. The November 2001 versions of Form CMS-855s will be delivered to all intermediaries, carriers, the National Supplier Clearinghouse, and regional offices by October 29, 2001.

Electronic copies of the application forms: www.hcfa.gov/medicare/enrollment/

CMS-855A (for Providers that bill Fiscal Intermediary) CMS-855B (for suppliers that bill Medicare Carriers), CMS-855I (all Individual Health care practitioners that bill Medicare Carriers), and CMS-855R (Individual health care practitioners to reassign Medicare benefits)

Medicare Payment Advisory Committee

	Reflect actual costs of practice expense for physician reimbursement
	Study the specific barriers imposed by Medicare on the provision of pain management procedures in hospital outpatient departments, Ambulatory Surgery Centers and physician’s offices

Physician Fee Schedule

	Scheduled fee reduction of 5.4% that would have been reduced to 0.9% under legislation, did not pass
	Conversion factor 2002 = 36.19

Ambulatory Surgery Center Update

	APCs for Medicare ASC payments will not be implemented on January 1, 2002.
	Legislation has been secured that prevents HCFA (now CMS) from implementing APCs for ASCs prior to January 1, 2002.
	CMS has not indicated that APCs will not be implemented at a later date
	Appears safe to assume that APCs will not be implemented in 2002.
	Implementation in 2003 does not appear likely either.

Trigger Point Injections

· CPT 20552: 1-2 muscle groups

· CPT 20553: 3 or more muscle groups (RVU: Same)

Outpatient Prospective Payment System

	Delay of the 2002 Update to the Outpatient Prospective Payment System (OPPS).
	Rates set to go into effect on January 1, 2002, will be delayed until April 1, 2002

PROPOSAL PUBLISHED 8/2001 FOR NEW APC RATES FOR 2002

FINAL RULE PUBLISHED 3/1/02 EFFECTIVE 4/1/02

Level VI nerve injections (proposed as level I interventional techniques)


Proposed to be reimbursed at $124.05


Final Rule: 3/1/02 Effective 4/1/02  $114.53

20552 – trigger point injection

20553 - trigger point injections

20600 – small joint injection

20605 – intermediate joint injection

20610 – large joint injection

64400 – trigeminal nerve block

64402 – facial nerve block

64405 – greate roccipital nerve block

64408 – vagus nerve block

64410 – phrenic nerve block

64412 – spinal accessory nerve block

64413– cervical plexus nerve block

64415 – brachial plexus nerve block

64417 – axillary nerve block

64418 –suprascapular nerve block

64425 –ilioinguinal nerve block

64430 – pudendal nerve block

64435 –paracervical (uterine) nerve block

64445 – sciatic nerve block

64450 – other peripheral nerve or branch block

64505– injection, anesthetic agent; sphenopalatine ganglion

64508 – carotid sinus (separate procedure)

64614 – chemodenervation extremity(s) and/or trunk muscle(s)

Level III nerve injections (proposed as Level II interventional techniques)


Proposed to be reimbursed at $197.27


Final Rule: 3/1/02 Effective 4/1/02  $184.27  


62270 – spinal puncture, lumbar, diagnostic

62272 – spinal puncture, therapeutic, for drainage of spinal fluid (by needle or catheter)

62273 – injection, epidural, of blood or clot patch

62310 – cervical/thoracic epidural

62311 – lumbar/caudal epidural

62318 – continuous epidural – cervical/thoracic

62319 – continuous epidural – lumbar/sacral

Level IV nerve injections (proposed as Level III interventional techniques)
Proposed to be reimbursed at $209.98
Final Rule: 3/1/02 Effective 4/1/02 $274.88

62280 – neurolytic subarachnoid

62281 – cervical/thoracic epidural - neurolytic

62282 – lumbar/sacral epidural - neurolytic

64420 – intercostal nerve block - single

64421 – intercostal nerve block - multiple

64470 – facet injection – cervical/thoracic - single

64472 - facet injection – cervical/thoracic - additional

64475 – facet injection – lumbar/sacral- single

64476 - facet injection – lumbar/sacral- additional

64479 – transforaminal cervical/thoracic - single

64480 - transforaminal cervical/thoracic - additional

64483 - transforaminal lumbar/sacral - single

64484 - transforaminal lumbar/sacral - additional

64510 – stellate ganglion block

64520 – lumbar or thoracic sympathetic block

64530 – celiac plexus block

64630 – pudendal nerve neurolysis

64640 – peripheral neurolysis

Level V nerve injections (proposed as Level IV interventional techniques)
Proposed to be reimbursed at $387
Final Rule: 3/1/02 Effective 4/1/02 $808.36

62263 – percutaneous epidural adhesiolysis

64600 – neurolytic – trigeminal – small branches

64605 – neurolytic – trigeminal – 2/3 division

64610 – neurolytic – trigeminal – at foramen ovale

64620 – intercostal neurolysis

64622 – facet neurolysis – lumbar/sacral - single

64623 - facet neurolysis – lumbar/sacral - additional

64626 - facet neurolysis – cervical/thoracic - single

64627 - facet neurolysis – cervical/thoracic - additional

64680 – celiac plexus neurolysis

CPT 63685 implantation of pulse generator $5719.00 (Final: $15,489.58)

CPT 63650 implantation of neural electrodes $1715.92 (Final: $13,698.78)

CPT 62361 $4824.40 (Final: $7,144.89)

Ambulatory Surgery Center Update

APCs for Medicare ASC payments will not be implemented on January 1, 2002.

Legislation has been secured that prevents HCFA (now CMS) from implementing APCs for ASCs prior to January 1, 2002.

CMS has not indicated that APCs will not be implemented at a later date

Appears safe to assume that APCs will not be implemented in 2002.

Implementation in 2003 does not appear likely either.