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CMS-1403-FC Impact of Work RVU Impact of PE RVU Combined Impact of PE Changes Changes and Work Changes* 2009 2009 (PE 2010 (PE 2010 Allowed Trans. (PE Full Trans. (PE Full Specialty Charges (mil) 2009 Year 3) Implement.) Year 3) Implement.) 24 NUCLEAR MEDICINE $ 79 0% -1% -2% -1% -1% 25 OBSTETRICS/GYNECOLOGY $ 654 0% 0% 0% 0% -1% 26 OPHTHALMOLOGY $ 5,026 0% 0% 0% 0% 0% 27 ORTHOPEDIC SURGERY $ 3,454 0% 0% 0% 0% -1% 28 OTOLARNGOLOGY $ 984 0% -1% -1% -1% -1% 29 PATHOLOGY $ 1,007 0% 0% 0% 0% 0% 30 PEDIATRICS $ 72 0% 1% 1% 1% 1% 31 PHYSICAL MEDICINE $ 850 0% 0% -1% 0% -1% 32 PLASTIC SURGERY $ 288 0% 0% 1% 0% 1% 33 PSYCHIATRY $ 1,169 0% 1% 1% 1% 1% 34 PULMONARY DISEASE $ 1,828 0% 1% 1% 1% 1% 35 RADIATION ONCOLOGY $ 1,854 0% -1% -2% -1% -2% 36 RADIOLOGY $ 5,554 0% 0% 1% 0% 1% 37 RHEUMATOLOGY $ 521 0% 0% -1% 0% -1% 38 THORACIC SURGERY $ 431 0% 0% 0% 0% 0% 39 UROLOGY $ 2,146 0% 0% 0% 0% 0% 40 VASCULAR SURGERY $ 685 0% 0% 0% 0% 0% 41 AUDIOLOGIST $ 33 1% -10% -20% -9% -19% 42 CHIROPRACTOR $ 768 0% -1% -1% -1% -1% 43 CLINICAL PSYCHOLOGIST $ 571 0% -2% -4% -2% -3% 44 CLINICAL SOCIAL WORKER $ 378 0% -2% -3% -1% -3% 45 NURSE ANESTHETIST $ 846 0% 0% 0% 0% 0% 46 NURSE PRACTITIONER $ 963 0% 1% 1% 1% 1% 47 OPTOMETRY $ 867 0% 0% 0% 0% 0% ORAL/MAXILLOFACIAL 48 SURGERY $ 38 0% 1% 2% 1% 2% PHYSICAL/OCCUPATIONAL 49 THERAPY $ 1,772 0% 2% 4% 2% 4% 50 PHYSICIAN ASSISTANT $ 711 0% 0% 1% 0% 1% 51 PODIATRY $ 1,727 0% 1% 3% 1% 2% 52 DIAGNOSTIC TESTING FACILITY $ 1,186 0% -2% -4% -2% -4% 53 INDEPENDENT LABORATORY $ 878 0% 5% 9% 5% 10% 54 PORTABLE X-RAY SUPPLIER $ 87 *Components may not sum to total due to rounding. 0% 2% 4% 2% 4% 2. Adjustments for Payments for Imaging Services Section 1848(c)(2)(B)(iv)(II) of the Act as added by section 5102 of the Deficit Reduction Act of 2005 (Pub. L. 109-171) (DRA) exempts the estimated savings from the application of the OPPS-based payment limitation on PFS 1042
CMS-1403-FC imaging services from the PFS BN requirement. We estimate that the combined impact of the current BN exemptions instituted by such section, the addition of 4 new codes and the removal of 2 codes from the list of services subject to the DRA OPPS cap (See section V. G. Additional Coding Issues), and the payment revisions to OPPS cap amounts would result in no measurable changes in the specialty specific impacts of the DRA provisions. 3. Combined Impact Table 48 shows the specialty-level impact of the work and PE RVU changes, the impact of the MIPPA provision to apply the BN adjustment to the CF, the MIPPA provision for a 1.1 percent increase to the CF, and the combined impact of all of these changes. Additionally, the impacts in this final rule with comment period rule reflect the use of the updated physician time data from the AMA-RUC, that is, used in step 13 of the detailed description of the PE methodology described in section II.A.1.i. of this final rule with comment period. As indicated in Table 48, our estimates of changes in Medicare revenues for PFS services compare payment rates for CY 2008 with payment rates for CY 2009 using CY 2007 Medicare utilization crosswalked to 2009 services. To the extent that there are year-to-year changes in the volume 1043
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<strong>CMS</strong>-1403-FC<br />
Impact of<br />
Work RVU Impact of PE RVU Combined Impact of PE<br />
Changes<br />
Changes<br />
and Work Changes*<br />
2009<br />
2009<br />
(PE 2010 (PE 2010<br />
Allowed<br />
Trans. (PE Full Trans. (PE Full<br />
Specialty<br />
Charges (mil) 2009 Year 3) Implement.) Year 3) Implement.)<br />
24 NUCLEAR MEDICINE $ 79 0% -1% -2% -1% -1%<br />
25 OBSTETRICS/GYNECOLOGY $ 654 0% 0% 0% 0% -1%<br />
26 OPHTHALMOLOGY $ 5,026 0% 0% 0% 0% 0%<br />
27 ORTHOPEDIC SURGERY $ 3,454 0% 0% 0% 0% -1%<br />
28 OTOLARNGOLOGY $ 984 0% -1% -1% -1% -1%<br />
29 PATHOLOGY $ 1,007 0% 0% 0% 0% 0%<br />
30 PEDIATRICS $ 72 0% 1% 1% 1% 1%<br />
31 PHYSICAL MEDICINE $ 850 0% 0% -1% 0% -1%<br />
32 PLASTIC SURGERY $ 288 0% 0% 1% 0% 1%<br />
33 PSYCHIATRY $ 1,169 0% 1% 1% 1% 1%<br />
34 PULMONARY DISEASE $ 1,828 0% 1% 1% 1% 1%<br />
35 RADIATION ONCOLOGY $ 1,854 0% -1% -2% -1% -2%<br />
36 RADIOLOGY $ 5,554 0% 0% 1% 0% 1%<br />
37 RHEUMATOLOGY $ 521 0% 0% -1% 0% -1%<br />
38 THORACIC SURGERY $ 431 0% 0% 0% 0% 0%<br />
39 UROLOGY $ 2,146 0% 0% 0% 0% 0%<br />
40 VASCULAR SURGERY $ 685 0% 0% 0% 0% 0%<br />
41 AUDIOLOGIST $ 33 1% -10% -20% -9% -19%<br />
42 CHIROPRACTOR $ 768 0% -1% -1% -1% -1%<br />
43 CLINICAL PSYCHOLOGIST $ 571 0% -2% -4% -2% -3%<br />
44 CLINICAL SOCIAL WORKER $ 378 0% -2% -3% -1% -3%<br />
45 NURSE ANESTHETIST $ 846 0% 0% 0% 0% 0%<br />
46 NURSE PRACTITIONER $ 963 0% 1% 1% 1% 1%<br />
47 OPTOMETRY $ 867 0% 0% 0% 0% 0%<br />
ORAL/MAXILLOFACIAL<br />
48 SURGERY $ 38 0% 1% 2% 1% 2%<br />
PHYSICAL/OCCUPATIONAL<br />
49 THERAPY $ 1,772 0% 2% 4% 2% 4%<br />
50 PHYSICIAN ASSISTANT $ 711 0% 0% 1% 0% 1%<br />
51 PODIATRY $ 1,727 0% 1% 3% 1% 2%<br />
52 DIAGNOSTIC TESTING FACILITY $ 1,186 0% -2% -4% -2% -4%<br />
53 INDEPENDENT LABORATORY $ 878 0% 5% 9% 5% 10%<br />
54 PORTABLE X-RAY SUPPLIER $ 87<br />
*Components may not sum to total due to rounding.<br />
0% 2% 4% 2% 4%<br />
2. Adjustments for Payments for Imaging Services<br />
Section 1848(c)(2)(B)(iv)(II) of the Act as added by<br />
section 5102 of the Deficit Reduction Act of 2005<br />
(Pub. L. 109-171) (DRA) exempts the estimated savings from<br />
the application of the OPPS-based payment limitation on PFS<br />
1042
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