July Update To The 2006 Medicare Physician Fee Schedule Database (MPFSDB)

The following are the July updates/additions to the 2006 Medicare Physician Fee Schedule Database (MPFSDB). These changes are effective for claims processed on or after January 1, 2006 unless otherwise noted.

Long Descriptor Changes:

The long descriptor for Category II code 1000F has been revised. The new descriptor is effective for services performed on or after January 1, 2005 (date code was implemented). 

· Procedure code 1000F   Long descriptor:  Tobacco use assessed (CAD¹, CAP¹, COPD¹, DM^4, PV¹)

The long descriptor for Category II code 4015F has been revised. The new descriptor is effective for services performed on or after January 1, 2006 (date code was implemented). 

· Procedure code 4015F   Long Descriptor (Revised):  Persistent asthma, preferred long term control medication or acceptable alternative treatment, prescribed ( Asthma¹) Short descriptor: Persist asthma medicine ctrl

The long descriptors for G9078, G9125, and G9127 (codes for 2006 Oncology Demonstration Project) have been revised.  The new descriptors are effective for services performed on or after January 1, 2006 (date codes were implemented).

· Procedure code G9078   Long descriptor:  Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t2 or t3a† gleason 8-10 or psa > 20 at diagnosis with no evidence of disease progression, recurrence, or metastases.

· Procedure code G9125   Long descriptor:  Oncology; disease status; chronic myelogenous leukemia, limited to Philadelphia chromosome positive and /or bcr-abl positive; blast phase not† in hematologic, cytogenetic, or molecular remission.

· Procedure code G9127   Long descriptor:  Oncology; disease status; chronic myelogenous leukemia, limited to Philadelphia chromosome positive and /or bcr-abl positive; extent of disease unknown, under evaluation, not listed (for use in a Medicare-approved demonstration project).

New Codes:

Effective July 1, 2006 the following category II codes will be added to the MPFSDB with a status indicator of ‘M’.  The payment modifiers are identical for all services.  Thus, the payment modifiers will only be listed for the first service (Category II code 0012F). The following codes are effective for services performed on or after July 1, 2006:

· Procedure code 0012F   Long Descriptor:  Community-acquired bacterial pneumonia assessed (CAP¹) Includes all of the following components: Co-morbid conditions assessed (1026F¹) Vital signs recorded (2010F¹) Mental status assessed (2014F¹) Hydration status assessed (2018F¹) Short Descriptor:  CAP bacterial assess. Procedure status=M.  WRVU=0.00.  Non-facility PE RVU=0.00 Facility PE RVU=0.00 Malpractice RVU=0.00.  PCTC=9.  Site of service=9.  Global surgery=XXX.  Multiple procedure=9.  Bilateral surgery=9.  Assistant at surgery=9.  Co-surgery=9.  Team surgery=9.  Diagnostic=9.  Type of service=1. Diagnostic Family Imaging Indicator=99

· Procedure code 1015F   Long Descriptor:  Chronic obstructive pulmonary disease (COPD) symptoms assessed (Includes assessment of at least one of the following:  dyspnea, cough/sputum, wheezing), or respiratory symptom assessment tool completed (COPD¹) Short Descriptor:  COPD symptoms assess

· Procedure code 1018F  Dyspnea assessed, not present (COPD¹) Short Descriptor: Assess dyspnea not present

· Procedure code 1019F  Dyspnea assessed, present (COPD1) Short Descriptor: Assess dyspnea present

· Procedure code 1022F  Pneumococcus immunization status assessed (CAP¹, COPD¹) Short Descriptor: Pneumo imm status assess

· Procedure code 1026F  Co-morbid conditions assessed (eg, includes assessment for presence or absence of:  malignancy, liver disease, congestive heart failure, cerebrovascular disease, renal disease, chronic obstructive pulmonary disease, asthma, diabetes, other co-morbid conditions) (CAP¹) Short Descriptor: Co-morbid condition assess

· Procedure code 1030F  Influenza immunization status assessed (CAP¹) Short Descriptor: Influenza imm status assess

· Procedure code 1034F  Current tobacco smoker (CAD¹, CAP¹, COPD¹, DM⁴, PV¹) Short descriptor: Current tobacco smoker 

· Procedure code 1035F  Current smokeless tobacco user (eg, chew, snuff) (PV¹) Short descriptor: Smokeless tobacco user

· Procedure code 1036F Current tobacco non-user (CAD¹, CAP¹, COPD¹, DM⁴, PV¹) Short descriptor: Tobacco non-user

· Procedure code 1038F Persistent asthma (mild, moderate or severe) Short descriptor: Persistent asthma

· Procedure code 1039F Intermittent asthma Short descriptor: Intermittent asthma

· Procedure code 2010F Vital signs recorded (includes at minimum: temperature, pulse, respiration, and blood pressure) (CAP¹) Short descriptor: Vital signs recorded

· Procedure code 2014F Mental status assessed (normal/mildly impaired/severely impaired)(CAP¹) Short descriptor: Mental status assess

· Procedure code 2018F Hydration status assessed (normal/mildly dehydrated/severely dehydrated)(CAP¹) Short descriptor: Hydration status assess

· Procedure code 2022F Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed (DM⁴) Short descriptor: Dil retina exam interp rev

· Procedure code 2024F Seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed (DM⁴) Short descriptor: 7 field photo interp doc rev

· Procedure code 2026F Eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed (DM⁴) Short descriptor: Eye image valid to dx rev

· Procedure code 2028F Foot examination performed (includes examination through visual inspection, sensory exam with monofilament, and pulse exam – report when any of the three components are completed) (DM⁴) Short descriptor: Foot exam performed

· Procedure code 3006F Chest X-ray results documented and reviewed(CAP¹) Short descriptor: Cxr doc rev

· Procedure code 3011F Lipid panel results documented and reviewed (must include total cholesterol, HDL-C, triglycerides and calculated LDL-C) (CAD¹) Short descriptor: Lipid panel doc rev

· Procedure code 3014F Screening mammography results documented and reviewed (PV¹) Short descriptor: Screen mammo doc rev

· Procedure code 3017F Colorectal cancer screening results documented and reviewed (PV¹)  (Includes:  fecal occult blood testing annually, flexible sigmoidoscopy every 5 years, annual fecal occult blood testing plus flexible sigmoidoscopy every 5 years, double-contrast barium enema every 5 years, or colonoscopy every 10 years) Short descriptor: Colorectal ca screen doc rev

· Procedure code 3020F Left ventricular function (LVF) assessment (eg, echocardiography, nuclear test, or ventriculography) documented in the medical record (Includes:  Quantitative or qualitative assessment results) (HF¹) Short descriptor: LVF assess

· Procedure code 3021F Left ventricular ejection fraction (LVEF) <40% or documentation of moderately or severely depressed left ventricular systolic function (CAD¹, HF¹) Short descriptor: LVEF mod/sever deprs syst

· Procedure code 3022F Left ventricular ejection fraction (LVEF) >=40% or documentation as normal or mildly depressed left ventricular systolic function (CAD¹, HF¹) Short descriptor: LVEF >=40% systolic

· Procedure code 3023F Spirometry results documented and reviewed (COPD¹) Short descriptor: Spirom doc rev

· Procedure code 3025F Spirometry test results demonstrate FEV₁/FVC<70% with COPD symptoms (eg, dyspnea, cough/sputum, wheezing)¹(CAP¹, COPD¹) Short descriptor: Spirom fev/fvc<70% w copd

· Procedure code 3027F Spirometry test results demonstrate FEV₁/FVC>=70% or patient does not have COPD symptoms (COPD¹) Short descriptor: Spirom fev/fvc>=70%/ w/o copd

· Procedure code 3028F Oxygen saturation results documented and reviewed (Includes assessment through pulse oximetry or arterial blood gas measurement) (CAP¹, COPD¹) Short descriptor: O2 saturation doc rev

· Procedure code 3035F Oxygen saturation ≤ 88 % or a PaO₂ <= 55 mm Hg (COPD¹) Short descriptor: O2 saturation <=88% /PaO <=55

· Procedure code 3037F Oxygen saturation > 88% or PaO₂ > 55 mmHg (COPD¹) Short descriptor: O2 saturation> 88% /PaO>55

· Procedure code 3040F Functional expiratory volume (FEV₁) < 40% of predicted value (COPD¹) Short descriptor: FEV<40% predicted value

· Procedure code 3042F Functional expiratory volume (FEV₁) >= 40% of predicted value (COPD¹) Short descriptor: FEV>= 40% predicted value

· Procedure code 3060F Positive microalbuminuria test result documented and reviewed (DM⁴) Short descriptor: Pos microalbuminuria rev

· Procedure code 3061F Negative microalbuminuria test result documented and reviewed (DM⁴) Short descriptor: Neg microalbuminuria rev

· Procedure code 3062F Positive macroalbuminuria test result documented and reviewed (DM⁴) Short descriptor: Pos macroalbuminuria rev

· Procedure code 3066F Documentation of treatment for nephropathy (eg, patient receiving dialysis, patient being treated for ESRD, CRF, ARF, or renal insufficiency, any visit to a nephrologist) (DM⁴) Short descriptor: Nephropathy doc tx

· Procedure code 3072F Low risk for retinopathy (no evidence of retinopathy in the prior year) (DM⁴) Short descriptor: Low risk for retinopathy

· Procedure code 4025F Inhaled bronchodilator prescribed (COPD¹) Short descriptor: Inhaled bronchodilator rx

· Procedure code 4030F Long term oxygen therapy prescribed (more than fifteen hours per day) (COPD¹) Short descriptor: Oxygen therapy rx

· Procedure code 4033F Pulmonary rehabilitation exercise training recommended (COPD¹) Short descriptor: Pulmonary rehab rec

· Procedure code 4035F Influenza immunization recommended (COPD¹) Short descriptor: Influenza imm rec

· Procedure code 4037F Influenza immunization ordered or administered (COPD¹, PV¹) Short descriptor: Influenza imm order/admin

· Procedure code 4040F Pneumococcal immunization ordered or administered (COPD¹) Short descriptor: Pneumoc imm order/admin

· Procedure code 4045F Appropriate empiric antibiotic prescribed (See measure developer’s Web site for definition of appropriate antibiotic) (CAP¹) Short descriptor: Empiric antibiotic rx

· Procedure code 4050F Hypertension plan of care documented as appropriate (HTN¹) Short descriptor: Ht care plan doc

· Procedure code 6005F Rationale (eg, severity of illness and safety) for level of care (eg, home, hospital) documented) (CAP¹) (Includes:  assessment of severity of illness and safety of home care) Short descriptor: Care level rationale doc

Effective July 1, 2006 the following Category III codes (0155T-0161T) will be added to the MPFSDB.  These codes are effective for services performed on or after July 1, 2006.

· Procedure code 0155T Laparoscopy, surgical, implantation or replacement of gastric stimulation electrodes, lesser curvature (ie, morbid obesity) Short descriptor:  Lap ins gastr eltrd for mo.  Procedure status=C.  WRVU=0.00.  Non-facility PE RVU=0.00 Facility PE RVU=0.00 Malpractice RVU=0.00.  PCTC=0.  Site of service=1.  Global surgery=XXX.  Multiple procedure=0.  Bilateral surgery=0.  Assistant at surgery=0.  Co-surgery=0.  Team surgery=0.  Diagnostic=9.  Type of service=2. Diagnostic Family Imaging Indicator=99.

· Procedure code 0156T Laparoscopy, surgical, revision or removal of gastric stimulation electrodes, lesser curvature (ie, morbid obesity) Short descriptor:  Lap redo gastr eltrd for mo.  Procedure status=C.  WRVU=0.00.  Non-facility PE RVU=0.00 Facility PE RVU=0.00 Malpractice RVU=0.00.  PCTC=0.  Site of service=1.  Global surgery=XXX.  Multiple procedure=0.  Bilateral surgery=0.  Assistant at surgery=0.  Co-surgery=0.  Team surgery=0.  Diagnostic=9.  Type of service=2. Diagnostic Family Imaging Indicator=99.

· Procedure code 0157T Laparotomy, implantation or replacement of gastric stimulation electrodes, lesser curvature (ie, morbid obesity) Short descriptor:  Opn ins gastr eltrd for mo.  Procedure status=C.  WRVU=0.00.  Non-facility PE RVU=0.00 Facility PE RVU=0.00 Malpractice RVU=0.00.  PCTC=0.  Site of service=1.  Global surgery=XXX.  Multiple procedure=0.  Bilateral surgery=0.  Assistant at surgery=0.  Co-surgery=0.  Team surgery=0.  Diagnostic=9.  Type of service=2. Family Imaging Indicator=99.

· Procedure code 0158T Laparotomy, revision or removal of gastric stimulation electrodes, lesser curvature (ie, morbid obesity) Short descriptor:  Opn redo gastr eltrd for mo.  Procedure status=C.  WRVU=0.00.  Non-facility PE RVU=0.00 Facility PE RVU=0.00 Malpractice RVU=0.00.  PCTC=0.  Site of service=1.  Global surgery=XXX.  Multiple procedure=0.  Bilateral surgery=0.  Assistant at surgery=0.  Co-surgery=0.  Team surgery=0.  Diagnostic=9.  Type of service=2. Family Imaging Indicator=99.

· Procedure code 0159T-TC/26 Computer aided detection, including computer algorithm analysis of MRI image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation, breast MRI (List separately in addition to code for primary procedure) Short descriptor:  Computer breast MRI add-on.  Procedure status=C.  WRVU=0.00.  Non-facility PE RVU=0.00 Facility PE RVU=0.00 Malpractice RVU=0.00.  PCTC=1.  Site of service=1.  Global surgery=ZZZ.  Multiple procedure=0.  Bilateral surgery=0.  Assistant at surgery=0.  Co-surgery=0.  Team surgery=0.  Diagnostic=9.  Type of service=9. Family Imaging Indicator=99.

· Procedure code 0160T Therapeutic repetitive transcranial magnetic stimulation treatment planning (Pre-treatment determination of optimal magnetic field strength via titration, treatment location determination and stimulation parameter and protocol programming in the therapeutic use of high power, focal magnetic pulses for the direct, non-invasive modulation of cortical neurons) Short descriptor:  Transcran mag stim planning.  Procedure status=C.  WRVU=0.00.  Non-facility PE RVU=0.00 Facility PE RVU=0.00 Malpractice RVU=0.00.  PCTC=0.  Site of service=1.  Global surgery=XXX.  Multiple procedure=0.  Bilateral surgery=0.  Assistant at surgery=0.  Co-surgery=0.  Team surgery=0.  Diagnostic=9.  Type of service=9. Family Imaging Indicator=99.

· Procedure code 0161T Therapeutic repetitive transcranial magnetic stimulation treatment delivery and management, per session (Treatment session uing high power, focal magnetic pulses for the direct, non-invasive modulation of cortical neurons. Clinical evaluation, safety monitoring and treatment parameter review in the therapeutic use of high power, focal magnetic pulses for the direct, non-invasive modulation of cortical neurons) Short descriptor:  Transcran mag stim delivery.  Procedure status=C.  WRVU=0.00.  Non-facility PE RVU=0.00 Facility PE RVU=0.00 Malpractice RVU=0.00.  PCTC=0.  Site of service=1.  Global surgery=XXX.  Multiple procedure=0.  Bilateral surgery=0.  Assistant at surgery=0.  Co-surgery=0.  Team surgery=0.  Diagnostic=9.  Type of service=9. Family Imaging Indicator=99.

The following G code (G8085) was inadvertently not included in the April Update to the MPFSDB (Change Request 4399, Transmittal 897, Pub 100-04, dated March 29, 2006).  G8085 will be added to the MPFSDB with a status indicator of “M”.  This code is effective for services performed on or after January 1, 2006.

· Procedure code G8085 End-stage renal disease patient requiring hemodialysis vascular access was not an eligible candidate for autogenous AV fistula Short descriptor:  ESRD pt inelig for autogenous fis.  Procedure status=M.  WRVU=0.00.  Non-facility PE RVU=0.00 Facility PE RVU=0.00 Malpractice RVU=0.00.  PCTC=9.  Site of service=9.  Global surgery=XXX.  Multiple procedure=9.  Bilateral surgery=9.  Assistant at surgery=9.  Co-surgery=9.  Team surgery=9.  Diagnostic=9.  Type of service=1. Diagnostic Family Imaging Indicator=99.

6/08/06