CMS reduces value of phototherapy codes

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This is the final article in a six-part series that focuses on areas where dermatology is vulnerable, and how members can take action to preserve the ability to practice the full scope of dermatology for the benefit of patients.  


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By Mark Lebwohl, MD

As you no doubt have read by now, the final 2014 Medicare fee schedule was released on Nov. 27 and contained some sobering news about phototherapy codes.

The AADA was anticipating that, based on the proposed 2014 Medicare Physician Fee schedule, reimbursement for dermatology-related phototherapy services would be cut by 50 to 60 percent. A cut of this magnitude would have surely reduced our ability to treat patients with psoriasis, vitiligo, cutaneous lymphoma, and eczema.

But, the 2014 Medicare fee schedule final rule stipulated that the actual cuts to 96910, 96912, and 96913 will be closer to an average of 9 percent.

Phototherapy code value reduction*

 96910 Photochemotherapy with uv-b
-9.3 percent
 96912 Photochemotherapy with uv-a  -8.8 percent
 96913 Photochemotherapy with uv-a or b
 -8.8 percent

*These calculations were made using a budget neutral Conversion Factor of 35.6446.

The reason for the cuts to not just phototherapy codes, but all codes, is based on the Medical Economic Index (MEI). It is used to develop the relative weights of the three components in payment codes under the fee schedule:

  • Work,
  • Practice expense (PE),
  • and malpractice (MP).

This year, the Centers for Medicare and Medicaid Services (CMS) made a significant change to the weighting of PE and physician work. The costs associated with non-physician clinicians who can bill independently for services under the fee schedule were taken out of the PE relative value weight and added to the weight of physician work.

Be diligent in the way you are coding for phototherapy services; continue to document what you are doing and code it appropriately.

As the Academy has stated in its recent member alert, because of these changes, payment for services that have high practice-expense components will go down and services whose values are primarily based on physician work will go up. Unfortunately, much of the value of many dermatology services comes from practice expenses. The value of some codes — including photochemotherapy codes — comes entirely from PE.

The effect of the 2014 MEI revision on dermatology is a 2 percent decrease in net payments. These across-the-board cuts are more of a reflection of the changing health care environment than an indictment of how we are using these codes.

That being said, I want to further echo the message that has carried through this series of six articles that have examined aspects of dermatology that may be vulnerable. We need to be cautious and ready for change.

The AADA has advocated for and will continue to defend dermatology, but much of the responsibility for maintaining the vitality of the specialty comes down to us as practitioners. Be diligent in the way you are coding for phototherapy services; continue to document what you are doing and code it appropriately.

We are anticipating that CMS will take another close look at phototherapy codes in the near future. For now, proper coding not only ensures our reimbursement, but provides us with the means to achieve our mission of providing quality patient care.

Dr. Lebwohl is professor and chairman of the department of dermatology at Mount Sinai School of Medicine in New York City. He has served as chairman of the AAD’s Psoriasis Task Force, and has directed the AAD's annual Psoriasis Symposium, Diagnostic Update Symposium, and Therapeutics Symposium. He is on the editorial board of the Journal of the American Academy of Dermatology (JAAD) and will take office as AAD president in March 2015.

Email the Member to Member editor at members@aad.org.

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