Medicare Payment Policies for 2010

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The Centers for Medicare & Medicaid Services (CMS) recently made two important announcements regarding the reimbursement of physicians and “non-physician practitioners” such as advanced practice RNs:

  • Beginning in January, Medicare will no longer recognize the higher paying CPT (Current Procedural Terminology) “consultation codes” which range from 99241 to 99245, and 99251 to 99255. Consulting provider visits on or after January 1, 2010 should be billed using the lower-paying evaluation and management (E/M) codes. This cost-cutting measure also chips away at the payment disparity between primary care providers and specialists. Details are available on the CMS website at

  • Anticipating a reverse by Congress of the scheduled 21.2% cut in the 2010 Medicare Physician Fee Schedule, CMS has instructed Medicare contractors to put a hold on paying such claims from January 1-15, 2010. Providers may also wait to submit these claims, avoiding the need for future adjustments. Contractors will then follow the rates in effect at that point. The hold does not affect claims for services provided before 2010. CMS has also extended the 2010 Annual Participation Enrollment Program end date from January 31, 2010, to March 17, 2010.