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<strong>CMS</strong>-1403-FC<br />

the TC of this service. These percentages are less than<br />

the 52.5 percent on average that is attributed to physician<br />

work and explains why payment for these services declines<br />

as a result of section 133(b) of the MIPPA. Similarly, the<br />

nonfacility amount for CPT code 99213 (Office/outpatient<br />

visit, est) increases by 0.5 percent because its work RVUs<br />

are a slightly higher proportion of its total payment<br />

(54 percent) than the 52.5 percent average for all<br />

physician services while the facility amount increases even<br />

more because its work RVUs as a percent of total RVUs<br />

(74 percent) are significantly higher than the proportion<br />

on average for all physician services. A hospital visit<br />

(CPT code 99223) and an emergency department visit (CPT<br />

code 99285) also show higher increases in payment (3 and<br />

4 percent respectively) due to section 133(b) of the MIPPA<br />

because physician work RVUs also account for a higher<br />

proportion of the total RVUs (76 and 80 percent<br />

respectively) than the average for all physician services.<br />

CPT/<br />

HCPCS<br />

TABLE 50: CY 2009 Impact of Placing Budget Neutrality<br />

Adjustment on the Conversion Factor<br />

(section 133(b) of the MIPPA)<br />

Mod Description<br />

Facility or<br />

Nonfacility<br />

Physician<br />

Work as a<br />

% of Total<br />

RVUs<br />

2009 BN on<br />

Work RVU<br />

2009 BN<br />

on CF<br />

1050<br />

Percent<br />

Change<br />

78465 Heart image (3d), multiple Nonfacility 11% $ 509.48 $ 485.46 -5%<br />

78465 TC Heart image (3d), multiple Nonfacility 0% $ 432.18 $ 406.47 -6%<br />

99213 Office/outpatient visit, est Nonfacility 54% $ 60.98 $ 61.26 0.5%<br />

99213 Office/outpatient visit, est Facility 74% $ 43.34 $ 44.69 3%

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