decisionhealth Newsletters, Coder Pink Sheets - 2023 Issue 7 (July)
CMS to kick 19 therapy codes back to the RUC for review
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Article Overview
This article explains how CMS is handling nominations and review requests under the proposed 2024 Medicare physician fee schedule. It focuses on a group of therapy services sent back for RUC review, plus other CPT and HCPCS code valuation questions involving practice expense, work RVUs, and contractor-priced status. The piece is aimed at coding and reimbursement professionals who track annual CMS valuation changes and need to understand which services are being reconsidered or left unchanged.
Why This Topic Matters
Annual fee schedule reviews can affect relative value units, payment status, and reimbursement expectations across multiple specialties. Readers who code or bill therapy, surgery, gynecology, urology, cardiology, and evaluation/management services will want to know which services CMS is reconsidering and which requests it is declining.
Article Sections
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Therapy codes nominated for RUC review
CMS discusses a set of therapy services flagged for reconsideration in the proposed fee schedule. The section summarizes the agency’s rationale for sending them back for additional review.
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Other potentially misvalued code requests
The article outlines several additional code valuation requests CMS received during its annual review cycle. These include requests involving therapeutic apheresis, colectomy, intracardiac catheter ablation, overnight monitoring, and a female urethral valve pump.
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CMS proposed decisions on nominated codes from 2022
CMS presents proposed responses to earlier nominations that remain under consideration. The section covers office-setting valuation, supply-related practice expense issues, and visit code review.
What You Will Learn
- How CMS handles potentially misvalued code nominations in the Medicare physician fee schedule process
- What types of code valuation issues can be raised during annual review cycles
- Which broad service areas are currently being reviewed or reconsidered by CMS
- How CMS distinguishes between requests for comment and decisions not to revalue
Who Should Read This
- Medical coders
- Coding managers
- Practice administrators
- Revenue cycle professionals
- Physician fee schedule analysts
- Therapy billing staff
Codes Discussed
Code Ranges Discussed
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