Year 2006 conversion factor set at $36.1770

Why This Topic Matters

The fee schedule update affects reimbursement across a wide range of Medicare services and specialties, so practices need to understand the scope of payment changes and policy adjustments for 2006. The article also highlights newly payable, no-longer-payable, and specially treated services that may affect revenue cycle planning and claims processing.

Article Sections

1. 2006 RBRVS conversion factor and Medicare spending outlook

   Overview of the annual physician fee schedule update, the conversion factor, and CMS spending projections for Medicare physician services.

2. Update formula and negative payment trends

   Discussion of the fee schedule update methodology, budget neutrality, and CMS commentary on longer-term update trends.

3. Payment hikes, cuts, and national service counts

   Summary of overall payment direction for 2006, including the number of payable services in different settings and broad changes to service availability.

4. State and locality payment effects

   Coverage of geographic payment adjustments, including Alaska and California locality issues.

5. Impact by specialty

   Table summarizing estimated payment effects across medical specialties based on the 2006 payment update and related adjustments.

6. Top Part B payment cuts in facility and office settings

   Tables highlighting selected services with the largest payment reductions under national rates for facility and office-based settings.

7. Relative Value Units and GPCIs

   Discussion of RVU changes, review processes, malpractice adjustments, practice expense methodology, and geographic practice cost indexes.

8. Anesthesiology

   Anesthesia-specific payment updates, new code treatment, sedation policy changes, and teaching anesthesiologist issues.

9. Drug payments

   Policy updates affecting drug-related reimbursement, including competitive acquisition, infusion-related add-ons, and dispensing payments.

10. Miscellaneous policy changes

    Additional Medicare payment and coverage changes involving imaging, Stark-related referrals, cancer care demonstration projects, screening benefits, telehealth, ESRD, opt-out rules, therapy services, supplies, and FQHC payments.

11. 194 new payable codes and billing opportunities in 2006

    Large table of newly payable services and their 2006 payment amounts across non-facility and facility settings.