Revisions to the Physician Fee Schedule under Medicare Part B for Calendar Year 2005

• Medicare Payment Policy under the Physician Fee Schedule for Calendar year 2005
• Medicare Payment Policy under the Physician Fee Schedule for Calendar year 2005 Continued
• Medicare Hospital Outpatient Prospective Payment System (OPPS) Changes for CY2005
• Medicare Hospital Outpatient Prospective Payment System (OPPS) Changes for CY2005 Continued
• Revisions to the Physician Fee Schedule under Medicare Part B for Calendar Year 2005
• Revisions to the Physician Fee Schedule under Medicare Part B for Calendar Year 2005 Continued
• Revisions to the Physician Fee Schedule under Medicare Part B for Calendar Year 2005 Continued (2)
• Medicare Part A Pass-Through Payment Update CY2005

As part of the revisions made under the Medicare program to the payment policies and physician’s fee schedule for calendar year 2005, CMS has issued in its final rule changes for the furnishing or administering of drugs and biologicals. However, as pointed out in the previous articles, CMS will be accepting comments on their ruling up until January 14, 2005.

Section 303 of the MMA (Medicare Modernization Act) required a transitional adjustment in calendar year 2004 that increased payments for specific drug administration services by 32 percent, and an increase of 3 percent in calendar year 2005. Also, as part of an effort to increase the payments for drug administration and other specific procedure codes, the CPT Editorial Panel’s Drug Administration Workgroup developed new CPT (procedure) codes for implementation in calendar year 2006. CMS acknowledges the efforts made by the CPT Editorial Panel, and have decided to create and implement temporary “G” codes for calendar year 2005 until such time they become permanent in 2006. CMS has divided the drug administration codes into three categories: infusion codes for hydration; codes for therapeutic/diagnostic injections and; chemotherapy administration codes. The descriptions of the codes were taken primarily from the AMA (American Medical Association) CPT Editorial Panel. A listing of the old CPT codes and their corresponding G-codes are provided in the tables below. Please note that some of the old CPT codes will correspond to more than one G-code, and there are codes that will allow a physician to bill for services that previously did not have a code or were bundled into other services:

Hydration codes

Injections and Infusions (Non-Chemotherapy, other than hydration)

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ZLB Behring assumes no responsibility for the individual interpretation of any material, facts, or references provided within the context of its publication of Reimbursement alert.

ZLB Behring assumes no responsibility for the individual interpretation of any material, facts, or references provided within the context of its publication of Reimbursement alert.