ASCRS Advocacy Prevents Decrease in Reimbursement for Cataract Code 66984 in 2016; Additional Changes to Conversion Factor and Phase-In of Code Reductions Including Glaucoma and Retina Codes

In the 2016 Medicare Physician Fee Schedule (MPFS) final rule, the cataract code 66984 reimbursement decreased 1% from $650.40 to $642.39 as a result of changes to the practice expense RVU. ASCRS realized that CMS had erroneously reduced the indirect practice expense for this code and notified CMS of this error. After discussions with CMS, they agreed to redo the calculations.

Earlier this week, CMS released updates to the 2016 MPFS, which include a correction to 66984. In the original 2016 final rule, the cataract code 66984 practice expense RVU was 8.80, which resulted in the reduction to 66984. In the recent update, CMS increased the practice expense RVU to 8.98. In the original final rule, the total RVU was 17.91 for 66984. As a result of the practice expense change issued this week, the total RVU has increased to 18.11.

In addition, in the 2016 final rule, the conversion factor was 35.8279. In the recently released 2016 MPFS updates, the conversion factor was reduced to 35.8043. This decrease was partially due to an error in the algorithm used by CMS, which caused the indirect practice expense to be calculated incorrectly for many codes. In addition, the phase-in was incorrectly applied for some ophthalmology codes including several glaucoma and retina codes as discussed below. Finally, the CY 2016 target recapture amount changed from –0.77 percent to –0.78 percent. It is not unusual for there to be minor changes to the conversion factor after the final rule.

In the 2016 MPFS final rule there were significant cuts to many retina and glaucoma codes. MACRA allows reductions of more than 20 percent to be phased-in over two years with 19 percent for the first year and the remainder of the cut the second year. There were errors to how the reductions were phased-in in the 2016 MPFS final rule, and those errors have also now been corrected.

For more details on specific codes, view the full Updated Relative Value Files.

If you have any questions, please contact Ashley McGlone at 703-591-2220.