CMS Releases Proposed 2010 Medicare Physician Fee Schedule

Proposed Policy Changes to Impact Neurology

July 16, 2009


The Centers for Medicare & Medicaid Services (CMS) published its proposed 2010 Medicare Physician Fee Schedule (MPFS) in the Federal Register on July 13. The proposed rule contains a number of important policy changes that have implications for neurologists.

Sustainable Growth Rate (SGR)

As expected, the proposed rule includes an estimated 2010 conversion factor update of -21.5 percent as a result of the flawed SGR formula. Therefore, CMS estimates the 2010 MPFS conversion factor will be set at approximately $28.3208, unless Congress acts to prevent it. Although there is no guarantee that Congress will do so this year, SGR reform would likely be part of any health care reform legislation.

Practice Expense Updates

CMS proposes updates to practice expense relative value units (RVUs) based on a survey the Academy conducted and funded in conjunction with the American Medical Association (AMA). The CMS impact analysis projects a six percent increase for neurology as a result of using the updated survey and other practice expense-related changes. This is offset by a negative two percent resulting primarily from elimination of consultation codes. CMS estimates the net impact of all changes will result in a three percent increase in Medicare reimbursement to neurology (not counting the proposed -21.5 percent conversion factor adjustment scheduled for 2010).

Elimination of Consultation Codes

Effective January 1, 2010, CMS is proposing to eliminate, in a budget neutral fashion, all of the inpatient and outpatient consultation codes. The agency would redistribute the work RVUs for these services to other E/M services, including new and established office visits and initial hospital and initial nursing facility visits. This would mean that physicians will no longer need to worry about complying with the complicated and ever-changing Medicare rules related to documentation of consults.

Whether the increased payment for other E/M services will make up for the elimination of the higher-paying consultation codes will likely depend on each individual physician's mix of consults and office/hospital visits and the percentage of established patients versus new patients.

The Academy's Medical Economics and Management Committee (MEM) is analyzing all of the implications in the proposed rule thoroughly, and will comment by the August 31, 2009, deadline.

Contact Katie Kuechenmeister at with comments or questions about this topic.