Third Update To The 2004 Medicare Physician Fee Schedule Database (MPFSDB)

The following are the third updates/additions to the 2004 Medicare Physician Fee Schedule Database (MPFSDB). These changes are effective for claims processed on or after January 1, 2004 unless otherwise noted.

Bilateral Surgery Indicator Changes:

· Procedure codes 23410, the Bilateral Surgery Indicator is changed from 0 (Bilateral payment adjustment does not apply) to 1 (Bilateral payment adjust does apply).

· Procedure code 33979-33980, the Bilateral Surgery Indicator is changed from 2 (150 percent payment adjustment for bilateral procedure does not apply) to 0 (Bilateral payment adjustment does not apply).

· Procedure code 52327 the Bilateral Surgery Indicator is changed from 0 (Bilateral payment adjustment does not apply) to 1 (Bilateral payment adjust does apply).

· Procedure code 69440-69700 the Bilateral Surgery Indicator is changed from 0 (Bilateral payment adjustment does not apply) to 1 (Bilateral payment adjust does apply).

· 69711-69979 the Bilateral Surgery Indicator is changed from 0 (Bilateral payment adjustment does not apply) to 1 (Bilateral payment adjust does apply).

Endoscopic Base Code Changes:

· Procedure codes 52320-52344, the EndoBase code is changed from 52005 to 52000.

Co-Surgeons (Modifier 62) Indicator Changes:

· Procedure Code 0001T, the co-surgeon indicator is changed from 0 (Co-surgeons not permitted for this procedure) to 2 (Co-surgeons permitted; no documentation required if two specialty requirements are met).

New Code:

· Procedure Code G0336, Description: PET imaging, brain imaging for the differential diagnosis of Alzheimer’s disease with aberrant features vs. frontal-temporal dementia. Short Description: PET imaging, brain Alzheimer’s. Procedure Code Status = C. PCTC Indictor = 1. Site of Service = 1. Global = XXX. Multiple Procedure Indictor = 0. Bilateral Procedure Indicator = 0. Assistant at Surgery Indictor = 9. Diagnostic Supervision = 9. Effective for services performed on or after September 15, 2004.

· Procedure Code G0336 -TC, Description: PET imaging, brain imaging for the differential diagnosis of Alzheimer’s disease with aberrant features vs. frontal-temporal dementia. Short Description: PET imaging, brain Alzheimer’s. Procedure Code Status = C. PCTC Indictor = 1. Site of Service = 1. Global = XXX. Multiple Procedure Indictor = 0. Bilateral Procedure Indicator = 0. Assistant at Surgery Indictor = 9. Diagnostic Supervision = 9. Effective for services performed on or after September 15, 2004.

· Procedure Code G0336-26, Description: PET imaging, brain imaging for the differential diagnosis of Alzheimer’s disease with aberrant features vs. fronto-tempral dementia. Short Description: PET imaging bran Alzheimer’s. Procedure code status = A. WRVU= 1.50. Facility/Non-Facility PE RVU= 0.51. Malpractice RVU= 0.05. PC/TC indicator = 1. Site of Service = 1. Global = XXX. Multiple Procedure Indicator = 0. Bilateral Procedure Indicator = 0. Assistant at Surgery Indicator = 9. Diagnostic Supervision = 9. Effective for services performed on or after September 15, 2004.

· Procedure Code G0341, Description: Percutaneous islet cell transplant, includes portal vein catheterization and infusion (To report imaging bill 75887 or 75885). Short Description: Percutaneous islet cell trans. Procedure code status = A. WRVU= 6.98. Facility/Non-Facility PE RVU= 2.73. Malpractice RVU= 0.48. PC/TC indicator = 0. Site of Service = 1. Global = 000. Multiple Procedure Indicator = 2. Bilateral Procedure Indicator = 0. Assistant at Surgery Indicator = 9. Diagnostic Supervision = 9. Effective for services performed on or after October 1, 2004.

· Procedure Code G0342, Description: Laparoscopy for Islet Cell Transplant, includes portal vein catheterization and infusion. Short Description: Laparoscopy islet cell trans. Procedure code status = A. WRVU= 11.92. Facility/Non-Facility PE RVU= 5.32. Malpractice RVU= 1.46. PC/TC indicator = 0. Site of Service = 1. Global = 090. Pre Op = 0.09. Intra Op = 0.81. Post Op = 0.10. Multiple Procedure Indicator = 2. Bilateral Procedure Indicator = 0. Assistant at Surgery Indicator = 2. Diagnostic Supervision = 9. Effective for services performed on or after October 1, 2004.

· Procedure Code G0343, Description: Laparoscopy for Islet Cell Transplant, includes portal vein catheterization and infusion. Short Description: Laparoscopy islet cell trans. Procedure code status = A. WRVU= 19.85. Facility/Non-Facility PE RVU= 8.82. Malpractice RVU= 2.05. PC/TC indicator = 0. Site of Service = 1. Global = 090. Pre Op = 0.09. Intra Op = 0.81. Post Op = 0.10. Multiple Procedure Indicator = 2. Bilateral Procedure Indicator = 0. Assistant at Surgery Indicator = 2. Diagnostic Supervision = 9. Effective for services performed on or after October 1, 2004

Pricing Updates - Corrections/Additions To The Physician Fee Schedule Amounts

California

New England

9/9/2004