AMA CPT® Assistant - 2005 Issue 3 (March)
Special Report..Medicare Physician Fee Schedule Spending in 1998 and 2003 (March 2005)
March 2005 pages 11-15 Coding Communication:Special Report..Medicare Physician Fee Schedule Spending in 1998 and 2003 The composition of spending for Medicare physician services has changed in recent years due to changes in medical technology, Medicare payment policy, and other factors. A key Medicare policy change was the phase-in of resource-based payment for physicians' practice expenses from 1999 to 2002. This article provides a brief summary of changes in spending for physician services billed to the Medicare program immediately before and after that policy change..from 1998 to 2003. The claims data presented within this article were obtained from...
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Article Overview
This article reviews changes in Medicare physician fee schedule spending between 1998 and 2003 using CMS claims data. It explains how spending shifted across places of service and broad CPT-based service groupings, and it highlights the highest-spending evaluation and management and non-E/M services during the period. The report is relevant for coders, billing staff, compliance teams, and analysts tracking Medicare payment trends and utilization changes.
Why This Topic Matters
It shows how Medicare payment policy and service utilization affected the distribution of physician fee schedule spending over time. Readers can use it to understand broad Medicare trends by setting and specialty area without relying on the premium article’s detailed tables.
Article Sections
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March 2005 pages 11-15
Introduces the report’s scope, data source, and time period, and frames the discussion around Medicare physician fee schedule spending trends.
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Medicare payment and utilization trends, 1998 to 2003
Summarizes overall changes in allowed charges, enrollment, utilization, and the impact of Medicare payment policy during the study period.
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Place of service changes
Reviews how spending shifted across office, hospital, and other care settings during the period covered by the report.
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Broad service category changes
Describes changes in spending distribution across major service groupings, including evaluation and management, surgery, radiology, pathology and laboratory, medicine, and other services.
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Top evaluation and management codes
Discusses the highest-spending evaluation and management services and compares their standing across the two years examined.
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Top non-E/M codes
Highlights the leading non-E/M services in Medicare spending and notes how selected procedures changed in frequency and allowed charges over time.
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Overall observations
Concludes with a brief discussion of how payment policy and technology influenced the composition of Medicare physician fee schedule spending.
What You Will Learn
- How Medicare physician fee schedule spending changed between 1998 and 2003
- Which broad service categories accounted for the largest shares of spending
- How spending varied by place of service
- Which evaluation and management services were highest in Medicare spending
- Which non-E/M services ranked highest in Medicare spending
- How CMS claims data were used to summarize physician fee schedule trends
Who Should Read This
- Medical coders
- Billing and reimbursement professionals
- Compliance staff
- Health policy analysts
- Practice managers
- Healthcare data analysts
Codes Discussed
Code Ranges Discussed
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