2013 Medicare physician fee schedule: issues of interest to independent laboratories

CMS announced a series of physician pay cuts impacting Pathologists in the final 2013 Physician Fee Schedule (PFS). Most notably, the agency lowered the technical component (TC) of the surgical pathology code 88305 by 52%, although it raised the professional component (PC) by 2%, beginning Jan. 1. This change alters the global payment for this code, which will decrease by 33% as a result of this revaluation.

In an apparent attempt to address a controversial policy announced by Palmetto GBA in August 2012, CMS revised the description of HCPCS code G0416 (surgical pathology; gross and microscopic examination for prostate need saturation biopsy sampling, 1-20 specimens) to cover 10-20 specimens.  According to CMS, this change will  ”better reflect the interaction of this service, and associated RVUs, with billing for surgical pathology.”  This change is open for public comment.  Laboratories presumably may now use 88305 if billing for less than 10 jars, but this revision does not address the confusion created by Palmetto GBA’s policy or the NCCI edit on which it is based because those statements seemed to say that laboratories must use G0416 regardless of collection methodology (and not just in the case of saturation biopsies).