American Society of Hematology

2012 Medicare Physician Fee Schedule Summary

Published on: July 26, 2011

On Friday July 1, 2011, the Centers for Medicare and Medicaid Services (CMS) posted a display copy of the proposed Medicare Physician Fee Schedule (PFS) for 2012. The proposed rule in its entirety can be found on the Office of the Federal Register website. The addenda to the rule, including Addendum B, which lists the proposed RVUs for each CPT code, can be found on the CMS website. (Please note: once this notice is published in the Federal Register the link will change). The provisions of the rule will be effective January 1, 2012 unless stated otherwise. Comments on the rule are due by COB August 30, 2011.

Highlights of the rule include:

  • Conversion Factor: The current CF, which expires on December 31, 2012, is $33.9764.  Without congressional action, the CF will be reduced by 29.5 percent in 2012, due to the SGR formula. Assuming that Congress acts to prevent this reduction, as it has in previous years, we estimate a 2012 CF identical to the 2011 CF in the prepared charts.
  • Specialty Impact: Most hematology/oncology procedural codes will see reductions of 1-3 percent, while bone marrow biopsy and bone marrow aspiration codes will see modest increases.  The total impact of the proposed changes in the rule is estimated to be 0 percent, and total allowed charges for hematology/oncology is $1,912,000,000. 
  • Bone Marrow Biopsy and Aspiration Tray: CMS accepted the ASH recommendation to adjust the pricing for the tray used for bone marrow biopsy and aspiration from $24.27 to $34.47.
  • RUC Review of Potentially Misvalued Codes: CMS is proposing that the AMA’s Relative Value Update Committee (RUC)review E/M codes as well as a few high-volume chemotherapy codes which have not been reviewed in the last 6 years. These codes include 96365, 96367 and 96413.
  • Physician Quality Reporting System (PQRS): CMS proposes to redefine a group practice for the group practice reporting option as 25 or more eligible professionals.CMS also proposes to reduce the number of options for 6-month registry-based measures reporting. 
  • PQRS Maintenance of Certification Program Incentive: CMS is proposing to significantly modify this program and require more frequent participation for CY 2012 through 2014.
  • The Electronic Prescribing Incentive Program: This program is transitioning into its penalty phase in 2012. Participation will be required in 2012 to avoid a 1.5 percent payment reduction in 2013.
  • Medicare Electronic Health Records Incentive Program: CMS proposes to harmonize the EHR incentive program with PQRS.

The full summary of the proposed Medicare Physician Fee Schedule is available, as is a chart listing the proposed MPFS payment rates.

back to top