decisionhealth Newsletters, Coder Pink Sheets - 2007 Issue 11 (November)
Medicare fee schedule gives RVUs for telephone codes, SBI codes
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Article Overview
This article reviews a Medicare fee schedule update and its impact on several CPT services commonly of interest to pediatric and primary care practices. It focuses on how the schedule treats telephone visit services, substance abuse screening and brief intervention services, and ocular photoscreening, and it explains why private insurers and Medicare contractors may approach these services differently. The article is relevant to coders, pediatricians, and billing staff who need to understand the scope of the 2008 fee schedule and the related CMS guidance discussed in the piece.
Why This Topic Matters
The article helps readers understand which services received valuation in the Medicare fee schedule, which were designated non-covered, and how those decisions may influence private payer pricing and Medicare contractor payment practices.
Article Sections
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Medicare Physician Fee Schedule 2008 overview
Introduces the fee schedule context and explains the broader payment environment for the year. It also frames the relationship between Medicare valuation and private payer fee setting.
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Telephone and online E/M services
Covers the telephone and online visit services discussed in the fee schedule and the general treatment of their valuation and coverage status. It also notes the role of relative value information and carrier pricing.
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Substance abuse screening and brief intervention services
Summarizes the fee schedule discussion for substance abuse screening and brief intervention services and the related CMS payment position. It also references the alternate Medicare carrier coding approach described in the article.
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Adolescent substance abuse screening context
Mentions a study about adolescent screening in primary care and places the coding discussion in a pediatric screening context. This section provides clinical context rather than coding instruction.
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Ocular photoscreening
Notes the fee schedule treatment of ocular photoscreening and its screening-service context. The discussion is brief and tied to Medicare coverage status.
What You Will Learn
- How the 2008 Medicare physician fee schedule relates to selected telephone, screening, and online services
- Which types of services are discussed as non-covered versus valued for fee-setting purposes
- How CMS guidance and carrier-level pricing concepts are presented in the article
- What broader pediatric and primary care screening context is used to frame the coding discussion
Who Should Read This
- Medical coders
- Pediatricians
- Primary care clinicians
- Billing and reimbursement staff
- Practice managers
Codes Discussed
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