CMS to increase eye-code payments; AAO fights 10.1% SGR-related cut

December 2, 2007

Washington, DC-The relinking of evaluation and management with eye-visit codes will result in a 2% increase in ophthalmology-related Medicare payments next year.

Washington, DC-The relinking of evaluation and management with eye-visit codes will result in a 2% increase in ophthalmology-related Medicare payments next year. This increase will help offset the plan by the Centers for Medicare and Medicaid Services (CMS) to cut the 2008 Medicare conversion factor by 10.1% under the sustainable growth rate (SGR) formula, which links Medicare reimbursement to the country’s gross domestic product.

The 2008 Medicare Physician Fee Schedule was issued in November and is effective in January.

“Convincing the American Medical Association (AMA) Relative-value Update Committee (RUC) and CMS about the importance of increased eye-visit code payments is the result of 2 years of hard work that has paid off in the new rule. These increased payments more accurately reflect the value of the services provided by physicians,” said Michael X. Repka, MD, secretary for federal affairs for the AAO.

“Our focus now is on trying to convince Congress to prevent the across-the-board cuts that we are facing from the SGR formula and implement a minimum 2-year positive update,” he added. The 2-year update would give physicians some stability and would allow Congress time to develop a long-term solution that corrects the problems created by SGR, according to the AAO.

CMS also continues to phase in new data on practice expenses; therefore, ophthalmologists face another 1% decrease in payments next year. The AAO has called on CMS to update data for all specialties and is working with the AMA to develop a new medicine-wide survey with the hopes of improving future payments related to ophthalmology.

Other changes that will be implemented with the new fee schedule:

• As part of the Physician Quality Reporting Initiative, CMS will provide an approximate 1.5% bonus for physicians who voluntarily report on quality measures next year.

• CMS has approved five new retina codes. The codes replace or modify existing codes.