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Changes
to the physician fee schedule could make it harder for leukemia
patients to obtain important tests next year, doctors recently
told the Centers for Medicare & Medicaid Services.
CPT
2005 deletes the old flow cytometry code (88180), which
paid for flow cytometry per marker. Instead, new codes will
cover just the technical components of flow cytometry for
the first marker (88184), and each additional marker (88185).
And new codes (88186-88189) will pay for interpretation
of flow cytometry for the first marker, the second through
eighth markers, ninth through 15th markers, and 16 or more
markers.
The
new payment methodology means a physician who interprets
15 markers will see a 71 percent cut in reimbursement in
2005 from the current $296, complained Jason DuBois, vice
president for government at the American Clinical Labs Association
during the Medicare Open Door Forum on the 2005 physician
fee schedule, held Nov. 15. This change will reduce patients'
access to flow cytometry, he charged.
"The
flow cytometry cuts suggest to me that there is some discrepancy
between the [Relative Value Update Committee] process and
reality," charged Patricia Gregg, a Florida pathologist.
CMS
officials responded the agency was concerned that under
the old methodology, Medicare was overpaying for the interpretation
by paying each marker separately. CMS worked with the Council
of American Pathologists and other doctors to solve this
problem, and "better recognize the physician resources
associated with the interpretation portion of the service,"
one official told the ODF. But CMS officials said they welcomed
any new pricing information pathologists could provide.
Pathologists
use flow cytometry to diagnose anyone suspected of having
leukemia, noted Raul Braylan, professor of pathology at
the University of Florida. "Not all flow cytometry
was created equal," he added. Some types are automated
and easy to administer, but others require expertise, training
and "labor-intensive activity." The more complex
types of flow cytometry will become harder to access as
a result of these cuts, he charged.
CMS
officials said they would consider comments on the final
fee schedule rule from providers. The agency could either
take comments into account in future rulemaking or make
interim changes to the fee schedule.
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