Medicare RVU OF - color Doppler CPT 93306

Relative Value Units

1.New combined TTE/spectral Doppler/color Doppler (CPT 93306)

CMS accepted the RUC’s recommendations for the work RVUs for both the new combined TTE/spectral Doppler/color Doppler code (93306). With respect to practice expense RVUs (PE-RVUs), CMS directed the RUC to determine whether its practice expense recommendations for CPT 93306 were consistent with the inputs for the component codes (93307/93325/93320). Since the new combined code was valued as a digital service while the current component codes were not, it is unclear how this issue will be resolved.

The chart set forth as Attachment B sets forth the RVUs for all of principal echo codes paid by Medicare. With respect to CPT 93306, please note the following:

• The work RVUs for CPT 93306 are .15 W-RVUs less than the combined W-RVUs for the component codes (93320, 93325 and 93307).
• The total RVUs for the new 93306 (7.42 RVUs) is approximately 1.16 RVUs lower than the total RVUs for the component codes (8.58); however, this is in part a temporary gap, since the RVUs for the component codes will be decreasing in 2010 by approximately .75 RVUs, as the result of the transition to resource-based RVUs.

2. New combined stress test/stress echo code )(CPT code 93351)
CMS also accepted the RUC recommended W-RVUs for the new combined stress test/stress echo code (93351) of 1.75 W-RVUs. However, it substantially reduced the increased echo equipment and echo table expenses approved by the RUC, substituting less costly equipment. CMS included in the equipment list a “dual” echocardiography image viewing and reporting system, although the agency established a base unit price of $85,000 in place of the $173,000 price provided by the specialty. These practice expense inputs are subject to comment.

With respect to CPT code 93351, please note:

• The W-RVUs for 93351 are .46 W-RVUs lower than the combined work RVUs for the stress test (.75) and the stress echo (1.46).
• The practice expense RVUs for 93351 are 5.60, while the combined PE-RVUs for stress test and stress echo services are 6.11 PE RVUs. This disparity will increase somewhat next year, when the practice expense increases for the current stress echo code (93350) are fully phased in. This differential is probably attributable in part to the loss of W-RVUs for the combined procedure, since PE-RVUs are based in part on W-RVUs.

3. New contrast add-on (CPT 93352)
The total RVUs for the new add-on code for contrast administration is 1.07 RVUs, which is approximately $36. If additional payment were allowed for contrast administration in conjunction with resting echo (which seems unlikely in light of the CCI rejection of ASE’s recent request), it seems unlikely that payment would exceed this amount.

The result of the changes will be a national average payment of approximately $267 for TTE/spectral Doppler/color Doppler (CPT 93306) ; $272 for stress test/stress echo (93351) and $308 for contrast enhanced stress test/stress echo (93352). It appears that Medicare payment for resting TTE/spectral Doppler/color Doppler will be approximately $42 (1.16 RVUs )lower than it would have been if the services had not been bundled, and that Medicare payment for the stress test/stress echo will be approximately $36 (approximately one RVU) lower than it would have been had these services remained unbundled.

In other action, CMS has decided not to move forward with its proposal to require physicians’ offices to register as IDTFs, and has substantially modified its anti-markup proposal such that the anti-markup rules will not apply to any PC or TC service performed by a physician who provides at least 75% of his or her professional services through a group. A separate memo will be posted soon to address the implications of this new rule for ASE members.

I also think these CPT s are deleted CPTs please chcek further.