CMS proposed rule maintains fee reduction for physicians

A 4.2% cut in physician fees called for in the proposed 2004 Medicare Fee Schedule will remain, despite a general consensus that the payment formula is flawed, ophthalmic lobbying groups predicted.

The Centers for Medicare and Medicaid Services attributed the reduction to a slow economy and to a significant growth in physician outlays last year, according to a news release issued by the agency. Yet the agency plans on paying about $48.7 billion to 900,000 physicians in 2004, increased from $47.9 billion projected for 2003.

According to a press release issued by the American Society of Cataract and Refractive Surgery, CMS officials said further refinements to the practice expense relative value unit (RVU) calculations will result in a 1% additional average reduction for services rendered by ophthalmologists. The rule also includes a revision of the Medicare Economic Index that will result in malpractice RVUs increasing by 21.7% and physician work and practice expense RVUs decreasing by 0.35% and 1.15%, respectively.

Key ophthalmology codes such as cataract, YAG and eye exams were increased as a result of refinements proposed by the American Academy of Ophthalmology, but the increases will effectively be wiped out by the proposed 4.2% cut, according to an AAO news release.

The AAO noted that it expects to see four new CPT codes for corneal amniotic tissue transplants, a new code for gold weight lid implant and a level 1 code for corneal pachymetry contained within the final rule.

The proposed rule is published today in the Federal Register, with a deadline for comments of Oct. 7.