2014 Medicare Physician Fee Schedule

Final Rule Summary

________________________________________________________

On Wednesday, November 27, 2013, the Centers for Medicare and Medicaid Services (CMS) released the
final Medicare Physician Fee Schedule (PFS) for 2014. The proposed rule updates payment policies and
payment rates for services furnished under the PFS and includes changes to the quality reporting initiatives
associated with the PFS – the Physician Quality Reporting System (PQRS), the Shared Savings Program
(ACOs), the EHR meaningful use program, and the physician value-based payment modifier.

The rule in its entirety and the addenda, including Addendum B, which lists the proposed RVUs for each
CPT code, can be found here. The provisions of the rule will be effective January 1, 2014 unless stated
otherwise.

The following summarizes the major provisions of the final rule, including the PQRS program. ASH will
provide an additional analysis of the final changes to the other quality programs following the annual
meeting.

SGR and Conversion Factor (CF) Impact

Congress has not yet resolved how it will deal with the potential massive reductions in the conversion
factor due to the Sustainable Growth Rate (SGR) formula. This has been a continuing issue for many
years, which Congress has dealt with at the last minute through short term fixes. The Senate Finance and
the House Ways and Means Committees have developed a proposal for resolving the SGR dilemma in
which a freeze would be imposed over the next 10 years. However, individual physicians and groups
would see some changes in their payment depending on how well they do under a Value Based
Performance (PBP) system. The VBP program would assess eligible professionals’ performance in the
following categories: 1) Quality; 2) Resource Use; 3) Clinical Practice Improvement Activities; and 4)
EHR Meaningful Use. The Energy and Commerce Committee passed legislation to repeal the SGR,
provide for a .5% update for five years, and create a quality performance program. It is unclear whether
Congress will enact a final bill before the end of the year.

The current conversion factor (CF), which expires on December 31, 2013, is $34.0230. Without
congressional action, the CF will be reduced to $27.2006. If the SGR reduction is prevented but the other
changes in the rule occur, the projected CF would be $35.6446. While we are reasonably confident that the
SGR reductions will be prevented (possibly only for the coming year, but hopefully permanently), this
might not occur until after January 1, 2014. It is expected that Congress would make the change retroactive
to January 1.

Specialty Impact
Table 93 (see Attachment 1), extracted from the rule, provides a summary of the impact of the final
changes in the rule by specialty. This chart does not include the impact of the potential additional 20%
SGR reduction for all physicians. The changes in the rule are budget-neutral in the aggregate which
explains why the impact for all physicians (i.e., total row) is shown as zero. Most specialties will see
changes in the range of plus or minus 3%. The specialties which see a change in excess of 5 percent
include: pathology (-6%), psychiatry (+6%), clinical psychologist and clinical social worker (+8%),
chiropractor (+12 %), and diagnostic testing facility (-11%).

Impact on Hematology/Oncology - CMS estimates a net overall change of minus 2 percent for hematology-
oncology without regard to the potential SGR reduction for all physicians. Attached to this summary are

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several charts comparing payment for evaluation and management services (E/M) and
hematology/oncology procedural services in 2013 to 2014.

Assuming that the SGR reductions are not enacted, the impact of the rule on Hematologists/Oncologists
will be as follows. Office-based E/M services would see minimal changes – the lower levels would be
slightly reduced while the higher levels of office visits would see slight increases. Hospital visits and
critical care would see increases in the 2 percent range. Most injection and infusion codes would see slight
reductions in payment. However, the infusion codes, which were reviewed by the RUC earlier this year,
would sustain slightly larger reductions as a result of some negative adjustments to the practice expense
inputs. The values for procedures performed in a facility or hospital setting (bone marrow aspiration,
apheresis, and transplant codes) are being increased while the payment for these services in the office
setting would see some reductions. Most of these changes are due to the proposed shifting of relative
values from practice expense to professional physician work due to the recalibration of the medical
economic index (discussed below).

Mis-valued Codes
Caps on Practice Expense RVUs for office-based services – In the proposed rule, CMS planned to cap the
practice expense RVUs assigned to certain codes provided in the non-facility (office) setting using the
hospital outpatient prospective payment system (HOPPS) as a limit. This would have had a large adverse
impact on some hematology services. ASH along with many other specialty societies commented on this
proposal pointing out its flaws. Based on these comments, CMS decided not to finalize this proposal at this
time.

Medicare Economic Index (MEI)

CMS is revising the calculation of the MEI, which is the price index used to update physician payments for
inflation by changing the relative RVU weights assigned to physician work and practice expense, resulting
in a redistribution of payment from PE to physician work as shown below:

Current 2014
Physician Work 48.266% 50.866%
Practice Expense 51.734% 49.134%
Total MEI 100% 100%

This change is generally beneficial to services performed in a hospital setting with relatively lower practice
expense shares as compared with the share assigned to professional work. Thus, specialties such as
anesthesiology were advantaged by the change while specialties with relatively higher practice expense
shares such as diagnostic testing facilities, allergy and dermatology were cut significantly. For
hematologists, services performed in hospital settings such as hospital visit codes and procedural services
(e.g., bone marrow biopsies) done in a facility setting generally benefited by the change while it is slightly
disadvantageous to office-based services.

Geographic Practice Expense Index (GPCI)

The GPCI is an adjustment CMS calculates and applies to both the work and practice expense relative
value units for each code to reflect differences in labor, rent and other cost elements based on geographic
areas. CMS changed its GPCI policies for 2014 using updated data and changed the weights assigned to
each GPCI consistent with the proposed MEI change. These changes will be phased in over 2014 and
2015. A complete listing of the changes can be found in Addenda D and E.

Incident-to Requirements
Currently when a service is billed by a non-physician practitioner (e.g. physician assistant, nurse
practitioner) the regulations require that the practitioner meet any State law requirements to be eligible to

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provide the service. However, the same requirement does not exist when services are performed in whole
or in part by auxiliary personnel but billed in the name of the physician under Medicare’s “incident to”
requirements. CMS is modifying the “incident to” rules to specify that all services and supplies must be
furnished in accordance with applicable State law and that auxiliary personnel performing “incident to”
services must meet any applicable State requirements, including State licensure, to perform the service.

Complex Chronic Care Management Services

As part of CMS ongoing effort to enhance payment for primary care, for CY 2015, CMS is establishing a
separate payment for complex chronic care management services furnished to patients with multiple (two
or more) complex chronic conditions that are expected to last at least 12 months or until death, and that
place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
Complex chronic care management services include physician development and revision of a plan of care,
communication with other treating professionals, and medication management.

In the final rule, CMS decided to establish a single code defined as follows: GXXX1 Chronic care
management services furnished to patients with multiple (two or more) chronic conditions expected to last
at least 12 months, or until the death of the patient, that place the patient at significant risk of death, acute
exacerbation/decompensation, or functional decline; 20 minutes or more; per 30 days. The service could be
provided by the physician and/or by staff under the physician’s direction. CMS is not proposing any
suggested RVUs for these codes at this time but invites comments on the work and PE that might be
assigned to these codes.

All of the complex chronic care management services, described in the rule, that are relevant to the patient
must be furnished in order to bill this code. If a face-to-face visit is provided during the 30-day period by
the practitioner who is furnishing complex chronic care management services, the practitioner should report
the appropriate evaluation and management code in addition to the chronic care management code.

CMS indicates that complex chronic care management services include transitional care management
services (CPT 99495, 99496), home health care supervision (HCPCS G0181), and hospice care supervision
(HCPCS G0182). To avoid what it considers duplicate payment, CMS stated that these services may not be
billed separately during the same 30 day period of time. In addition, multiple practitioners cannot bill for
chronic care management for the same period of time.

CMS proposed the following as potential requirements:

 Practitioner must be using a certified Electronic Health Record (EHR) for beneficiary care that is
integrated into the practice to support access to care, care coordination, care management and
communication.

 Practitioner must employ one or more advanced practice registered nurses or physicians assistants
whose responsibilities include providing complex chronic care management.

 Written protocols must be established that describe:

- methods for furnishing complex chronic care management services

- strategies for systematically furnishing health risk assessments to identify all eligible beneficiaries
- procedures for informing eligible beneficiaries about complex chronic care management services
and obtaining their consent
- steps for monitoring the medical, functional and social needs of all beneficiaries receiving complex
chronic care management services

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 - system based approaches to ensure timely delivery of all recommended preventive care services to
beneficiaries; communicating common and anticipated clinical and non-clinical issues to
beneficiaries
- care plans for beneficiaries post-discharge from an emergency department or other institutional
health care setting
- a systematic approach to communicate and electronically exchange clinical information with and
coordinate care among all service providers involved in the ongoing care of a beneficiary receiving
complex chronic care management services
- a systematic approach for linking the practice and a beneficiary receiving complex chronic care
management services with long-term services
- a systematic approach to the care management of vulnerable beneficiary populations such as racial
and ethnic minorities and people with disabilities
- patient education to assist the beneficiary to self-manage a chronic condition

Several societies, including ASH, raised questions about the necessity for some of the proposed
requirements such as the need to employ advanced practice nurses. CMS responded to most of the
comments by indicating that they would be considered for future rulemaking. CMS did accept the
suggestion made by ASH to make it clear that specialists can utilize this code in addition to primary care
physicians. However, they did not accept the suggestion that management of a single chronic condition
could qualify for use of the code - 2 or more chronic conditions must be present.

Clinical Laboratory Fee Schedule (CLFS)

In the proposed rule, CMS outlined a process to review the 1,250 codes on the CLFS. CMS estimated that
it will be a significant administrative process and take a minimum of 5 years to review. In the final rule,
CMS states that it will conduct a data analysis of codes on the CLFS each year to determine the codes for
review and potential payment adjustment. This will involve examining codes in several different ways
such as looking at those on the CLFS the longest period of time as well as focusing on high volume and
high dollar codes. The public will also be invited to identify codes for review. This process will begin with
the proposed rule for 2015.

Physician Quality Reporting System (PQRS)

Those who successfully report quality measures in 2014 will receive a bonus payment of 0.5 percent of
total allowed charges for services provided during the reporting period. An additional 0.5 percent will be
available for those who participate in a maintenance of certification (MOC) program required for board
certification by a recognized physician specialty organization in 2014. As mandated by Congress, those
providers who do not report quality measures in CY 2014 will have their payments adjusted in CY 2016.
The initial penalty will be -2.0 percent.

In the final rule, CMS takes steps to align reporting requirements across its quality programs, including the
PQRS, the Medicare Shared Savings Program (ACOs), the EHR Incentive Program and the value-based
payment modifier.

Reporting Mechanisms. PQRS continues to provide eligible professionals with reporting mechanism
options. The program retained the claims, registry, EHR, administrative claims and the GPRO web-
interface options and added a new certified survey vendor reporting mechanism for the purposes of
reporting CG CAHPS measures and a qualified clinical data registry reporting mechanism.

- Clinical Group Consumer Assessment of Healthcare Providers and Systems (CG CAHPS) Survey.
CMS is proposing the option of completing CG CAHPS survey to satisfy the 2014 incentive and to
avoid the 2016 payment adjustment.

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 - Qualified Clinical Data Registries. This new reporting mechanism will allow eligible
professionals to use the measures in a clinical data registry to satisfy the PQRS reporting
requirements. Eligible professionals would report on all patients, regardless of whether they are
Medicare Part B patients. To receive the 2014 PQRS incentive payment, providers participating in
qualified registries must report at least 9 measures covering at least 3 of the National Quality
Strategy (NQS) domains and report each measure for at least 50% of the provider’s applicable
patients. To avoid the penalty in 2016, providers must report3 measures covering 1 NQS domain
for 50% of applicable patients. These registries will be held to stringent standards; specifically,
they must be capable of benchmarking

Criteria to Satisfactorily Report. All eligible professionals who satisfy the requirements to earn an
incentive payment in 2014 will not be subject to the payment adjustment in 2016. To earn the incentive
and avoid the payment adjustment, eligible providers are required to report at least 9 measures covering 3
of the National Quality Strategy domains for 50 percent of the Medicare Part B patients they see during the
reporting period. Complete details on the reporting requirements by reporting method can be found in the
table below. CMS will continue to allow eligible professionals using the claims-based reporting
mechanism to report 3 measures on 50 percent of their applicable patients to avoid the payment adjustment.

Reporting for Individual Eligible Professionals

Claims-Based Reporting
Reporting Criteria Reporting Period
- Report at least 9 PQRS measures covering at least 3 of the 12 month (January 1 -
National Quality Strategy domains, OR, December 31)
- If less than 9 measures apply to the eligible professional, 1-8
measures, AND
- Report each measure for at least 50% of the Medicare Part B
FFS patients seen during the reporting period to which the
measure applies.
- Measures with 0% performance rate will not be counted.
Registry-Based Reporting
Reporting Criteria Reporting Period
- Report at least 9 PQRS measures, covering at least 3 of the 12 month (January 1 -
National Quality Strategy domains, AND December 31)
- Report each measure for at least 50% of Medicare Part B FFS
patients to which the measure applies.
- Measures with a 0% performance rate will not be counted
Qualified Clinical Data Registry
Reporting Criteria Reporting Period
- Report at least 9 PQRS measures available for reporting under a 12 month (January 1 -
qualified clinical data registry covering at least 3 of the National December 31)
Quality Strategy domains, AND
- Report each measure for at least 50% of the eligible
professional’s patients.
- Of the measures reported via a clinical data registry, at least one
reported measure must be an outcomes measure.

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 Reporting for Group Practices

Qualified Registry – 2+ Eligible Professionals

Reporting Criteria Reporting Period
- Report at least 9 PQRS measures covering at least 3 of the 12 month (January 1 -
National Quality Strategy domains, AND December 31)
- Report each measure for at least 50% of the Medicare Part B
FFS patients seen during the reporting period to which the
measure applies.
- Measures with 0% performance rate will not be counted.
Certified Survey Vendor + Qualified Registry, Direct EHR Product, EHR Data Submission Vendor
or GPRO Web Interface – 25+ Eligible Professionals
Reporting Criteria Reporting Period
- Report all CG CAHPS survey measures via certified survey 12 month (January 1 -
vendor, AND December 31)
- Report all 6 measures covering at least 2 of the National Quality
Strategy domains

Quality Measures. CMS finalized an additional 57 new individual measures and 2 measures groups, as
well as retired some claims-based measures to encourage reporting via registry and EHR.

All proposed measures have been classified into 1 of 6 domains based on the National Quality Strategy’s
six priorities:
1. Person and Caregiver-Centered Experience and Outcomes
2. Patient Safety
3. Communication and Care Coordination
4. Community/Population Health
5. Efficiency and Cost Reduction
6. Effective Clinical Care

Maintenance of Certification Program Incentive. CY 2014 is the final year for which this program is
authorized, and CMS is keeping the self-nomination process and standards for this program consistent. The
MOC program requires eligible professionals to:
1. Maintain a valid and unrestricted license in the United States;
2. Participate in educational and self-assessment programs;
3. Demonstrate through a formalized secure examination that the physician has fundamental
diagnostic skills, medical knowledge and clinical judgment to provide care in his specialty; and
4. Successfully complete a qualified maintenance of certification program practice assessment.

CMS requires an eligible professional to participate more frequently than is required in at least one of the
four parts of the MOC program, not all four. CMS will look to the specific requirements of Board
certification to determine if the “more frequently” requirement is met. However, CMS will interpret the
statute to require the participation and successful completion in at least one MOC program practice
assessment for each year the physician participates in the MOC Program Incentive.

More information on PQRS can be found here.

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TABLE 93: CY 2014 PFS Final Rule with Comment Period Estimated Impact Table: Impacts of Work, Practice
Expense, and Malpractice RVUs, and the MEI Adjustment*

(A) (B) (C) (D) (E) (F)

Impact of RVU Changes Impact of
Adjusting the
Allowed Impact of Impact of RVUs to Combined
Specialty
Charges (mil) Work & MP PE RVU Match the Impact
RVU Changes Changes Revised MEI
Weights
TOTAL $87,552 0% 0% 0% 0%
ALLERGY/IMMUNOLOGY $214 0% 0% -3% -3%
ANESTHESIOLOGY $1,871 0% 0% 1% 1%
CARDIAC SURGERY $357 0% 0% 2% 2%
CARDIOLOGY $6,461 0% 2% -1% 1%
COLON AND RECTAL SURGERY $159 0% 0% 0% 0%
CRITICAL CARE $276 0% 0% 2% 2%
DERMATOLOGY $3,123 -1% 1% -2% -2%
EMERGENCY MEDICINE $2,946 0% 0% 2% 2%
ENDOCRINOLOGY $449 0% 0% 0% 0%
FAMILY PRACTICE $6,402 0% 0% 0% 0%
GASTROENTEROLOGY $1,909 -1% -1% 0% -2%
GENERAL PRACTICE $536 0% 0% 0% 0%
GENERAL SURGERY $2,254 0% 0% 0% 0%
GERIATRICS $235 0% 0% 1% 1%
HAND SURGERY $151 0% 0% -1% -1%
HEMATOLOGY/ONCOLOGY $1,896 0% 0% -2% -2%
INFECTIOUS DISEASE $639 0% 0% 2% 2%
INTERNAL MEDICINE $11,503 0% 0% 1% 1%
INTERVENTIONAL PAIN MGMT $644 -1% -2% -1% -4%
INTERVENTIONAL RADIOLOGY $221 -1% 0% -1% -2%
MULTISPECIALTY CLINIC/OTHER PHY $80 0% -1% 1% 0%
NEPHROLOGY $2,134 0% 0% 1% 1%
NEUROLOGY $1,509 0% -1% 0% -1%
NEUROSURGERY $718 0% 0% 0% 0%
NUCLEAR MEDICINE $51 0% 0% 0% 0%
OBSTETRICS/GYNECOLOGY $693 0% 2% -1% 1%
OPHTHALMOLOGY $5,609 0% 0% 0% 0%
ORTHOPEDIC SURGERY $3,702 -1% -1% 0% -2%
OTOLARNGOLOGY $1,133 0% -1% -1% -2%
PATHOLOGY $1,141 -4% -2% 0% -6%
PEDIATRICS $64 0% 0% 0% 0%
PHYSICAL MEDICINE $1,007 0% -1% 0% -1%
PLASTIC SURGERY $372 0% 0% 0% 0%
PSYCHIATRY $1,181 4% 1% 1% 6%
PULMONARY DISEASE $1,783 0% 0% 1% 1%
RADIATION ONCOLOGY $1,788 0% 3% -2% 1%
RADIOLOGY $4,655 0% -2% 0% -2%
RHEUMATOLOGY $553 0% -2% -2% -4%

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THORACIC SURGERY $335 0% 0% 1% 1%
UROLOGY $1,864 0% -1% 0% -1%
VASCULAR SURGERY $931 0% -1% -1% -2%
AUDIOLOGIST $57 0% 1% -1% 0%
CHIROPRACTOR $729 5% 6% 1% 12%
CLINICAL PSYCHOLOGIST $587 6% -1% 3% 8%
CLINICAL SOCIAL WORKER $414 6% -2% 4% 8%
DIAGNOSTIC TESTING FACILITY $790 0% -6% -5% -11%
INDEPENDENT LABORATORY $818 -2% 0% -3% -5%
NURSE ANES / ANES ASST $1,061 0% 0% 3% 3%
NURSE PRACTITIONER $1,954 0% 0% 1% 1%
OPTOMETRY $1,116 0% 0% -1% -1%
ORAL/MAXILLOFACIAL SURGERY $45 0% 1% -2% -1%
PHYSICAL/OCCUPATIONAL THERAPY $2,818 0% 1% -1% 0%
PHYSICIAN ASSISTANT $1,414 0% 0% 0% 0%
PODIATRY $1,998 0% 0% -1% -1%
PORTABLE X-RAY SUPPLIER $113 0% 2% -4% -2%
RADIATION THERAPY CENTERS $63 0% 5% -6% -1%
OTHER $25 0% 0% 1% 1%
* Table 93 shows only the payment impact on PFS services. These impacts use a constant conversion factor and thus
do not include the effects of the January 2014 conversion factor change required under current law.

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 2014 Final Physician Fee Schedule (CMS 1600-FC)
Payment Rates for Medicare Physician Services - Hematology/Oncology
NON-FACILITY (OFFICE) FACILITY (HOSPITAL)
CPT 2013 2014 2013 2014
Descriptor % CHANGE % CHANGE
Code CF = CF = CF = CF =
2013-2014 2013-2014
$34.0230 $35.8228 $34.0230 $35.8228
36430 Blood transfusion service $34.70 $34.03 -1.94% NA NA NA
36511 Apheresis wbc NA NA NA $96.63 $98.15 1.58%
36512 Apheresis rbc NA NA NA $93.22 $96.72 3.75%
36513 Apheresis platelets NA NA NA $99.35 $102.45 3.13%
36514 Apheresis plasma $551.85 $525.52 -4.77% $94.58 $97.44 3.02%
36515 Apheresis, adsorp/reinfuse $2,231.91 $2,087.39 -6.47% $87.78 $90.27 2.84%
36516 Apheresis, selective $2,176.79 $2,042.62 -6.16% $71.45 $73.08 2.28%
36522 Photopheresis $1,456.52 $1,358.40 -6.74% $103.43 $104.60 1.13%
38205 Harvest allogenic stem cells NA NA NA $80.29 $83.11 3.51%
38206 Harvest auto stem cells NA NA NA $82.00 $84.54 3.11%
38220 Bone marrow aspiration $165.01 $161.92 -1.87% $59.88 $62.33 4.09%
38221 Bone marrow biopsy $167.73 $167.65 -0.05% $73.83 $77.02 4.32%
38230 Bone marrow collection NA NA NA $208.22 $216.01 3.74%
38232 Bone marrow harvest autolog NA NA NA $208.22 $214.22 2.88%
38240 Bone marrow/stem transplant NA NA NA $165.35 $230.70 39.52%
38241 Bone marrow/stem transplant NA NA NA $164.33 $172.31 4.85%
38242 Lymphocyte infuse transplant NA NA NA $115.00 $120.36 4.67%
88184 Flowcytometry/ tc, 1 marker $88.80 $87.77 -1.16% NA NA NA
88185 Flowcytometry/ tc, add-on $54.10 $53.73 -0.67% NA NA NA
88187 Flowcytometry/read, 2-8 $68.73 $71.65 4.25% $68.73 $71.65 4.25%
88188 Flowcytometry/read, 9-15 $87.78 $90.27 2.84% $87.78 $90.27 2.84%
88189 Flowcytometry/read, 16 & < $106.49 $110.69 3.94% $106.49 $110.69 3.94%
96360 Hydration iv infusion, init $58.52 $56.96 -2.67% NA NA NA
96361 Hydrate iv infusion, add- on $15.31 $15.05 -1.73% NA NA NA
96365 Ther/ proph/ diag iv inf, init $75.53 $68.78 -8.94% NA NA NA
96366 Ther/ proph/ dg iv inf, add- on $21.77 $18.63 -14.45% NA NA NA
96367 Tx/ proph/ dg addl seq iv inf $31.98 $30.09 -5.91% NA NA NA
96368 Ther/ diag concurrent inf $18.71 $20.42 9.12% NA NA NA
96372 Ther/ proph/ diag inj, sc/ im $25.86 $25.08 -3.02% NA NA NA
96373 Ther/ proph/ diag inj, ia $20.07 $19.34 -3.63% NA NA NA
96374 Ther/ proph/ diag inj, iv push $57.50 $56.24 -2.19% NA NA NA
96375 Ther/ proph/ diag inj add- on $22.46 $22.21 -1.09% NA NA NA
96401 Chemotherapy, sc/im $75.87 $73.79 -2.74% NA NA NA
96402 Chemo hormon antineopl sq/ im $32.66 $31.88 -2.39% NA NA NA
96405 Intralesional chemo admin $84.04 $81.32 -3.24% $29.94 $30.45 1.70%
96406 Intralesional chemo admin $118.40 $113.56 -4.09% $45.25 $46.57 2.91%
96409 Chemo, iv push, sngl drug $111.94 $108.90 -2.71% NA NA NA
96411 Chemo, iv push, addl drug $62.60 $61.26 -2.15% NA NA NA
96413 Chemo, iv infusion, 1 hr $143.24 $133.26 -6.96% NA NA NA
96415 Chemo, iv infusion, addl hr $30.62 $27.94 -8.75% NA NA NA
96416 Chemo prolong infuse w/ pump $142.56 $138.99 -2.50% NA NA NA
96417 Chemo iv infus each addl seq $71.11 $61.97 -12.85% NA NA NA
96420 Chemotherapy, push technique $107.51 $104.24 -3.04% NA NA NA
96422 Chemotherapy,infusion method $172.50 $167.65 -2.81% NA NA NA
96423 Chemo, infuse method add-on $79.61 $77.38 -2.81% NA NA NA
96425 Chemotherapy,infusion method $185.43 $180.55 -2.63% NA NA NA
96440 Chemotherapy, intracavitary $905.35 $854.73 -5.59% $139.15 $142.22 2.20%
96446 Chemotx admn prtl cavity $200.06 $193.44 -3.31% $21.43 $22.21 3.62%
96450 Chemotherapy, into CNS $180.66 $181.98 0.73% $78.25 $82.03 4.83%
96521 Port pump refill & main $140.86 $135.05 -4.12% NA NA NA
96522 Refill/ maint pump/ resvr syst $114.32 $111.05 -2.86% NA NA NA
96523 Irrig drug delivery device $25.18 $24.72 -1.82% NA NA NA
96542 Chemotherapy injection $121.80 $118.57 -2.65% $40.83 $42.63 4.41%
99363* Anticoag mgmt, init $127.25 $127.89 0.50% $82.68 $85.62 3.56%
99364* Anticoag mgmt, subseq $42.87 $43.35 1.11% $31.64 $32.60 3.03%
G0364 Bone marrow aspirate &biopsy $12.25 $12.54 2.37% $8.51 $8.96 5.29%

*These codes are considered bundled by Medicare and are not separately paid. However, CMS published the RVUs for informational
purposes and for use by other payers.
 2014 Final Physician Fee Schedule (CMS 1600-FC)
Payment Rates for Medicare Physician Services - Evaluation and Management
NON-FACILITY (OFFICE) FACILITY (HOSPITAL)
CPT 2013 2014 2013 2014
Descriptor % CHANGE % CHANGE
Code CF = CF = CF = CF =
2013-2014 2013-2014
$34.0230 $35.8228 $34.0230 $35.8228
99201 Office/outpatient visit, new $43.89 $43.35 -1.24% $25.86 $26.51 2.52%
99202 Office/outpatient visit, new $74.51 $74.51 0.00% $48.99 $50.51 3.10%
99203 Office/outpatient visit, new $108.19 $108.18 -0.01% $75.19 $77.02 2.43%
99204 Office/outpatient visit, new $164.67 $166.22 0.94% $128.27 $131.83 2.78%
99205 Office/outpatient visit, new $203.80 $207.06 1.60% $164.67 $170.16 3.33%
99211 Office/outpatient visit, est $20.41 $20.06 -1.73% $8.85 $9.31 5.29%
99212 Office/outpatient visit, est $43.89 $43.70 -0.42% $24.50 $25.43 3.83%
99213 Office/outpatient visit, est $72.81 $73.08 0.37% $49.67 $51.58 3.85%
99214 Office/outpatient visit, est $106.83 $107.83 0.93% $76.55 $79.17 3.42%
99215 Office/outpatient visit, est $142.90 $144.37 1.03% $107.85 $111.41 3.30%
99221 Initial hospital care NA NA NA $99.35 $102.09 2.77%
99222 Initial hospital care NA NA NA $134.73 $138.63 2.90%
99223 Initial hospital care NA NA NA $198.01 $204.19 3.12%
99231 Subsequent hospital care NA NA NA $38.11 $39.41 3.41%
99232 Subsequent hospital care NA NA NA $70.09 $72.36 3.25%
99233 Subsequent hospital care NA NA NA $101.05 $104.24 3.16%
99291 Critical care, first hour $272.18 $274.76 0.95% $217.75 $224.61 3.15%
99292 Critical care, add'l 30 min $120.78 $123.23 2.03% $109.55 $112.48 2.67%
99471 Ped critical care, initial NA NA NA $834.58 $857.60 2.76%
99472 Ped critical care, subseq NA NA NA $396.71 $403.72 1.77%
99495 Trans care mgmt 14 day disch $163.99 $164.07 0.05% $134.73 $111.41 -17.31%
99496 Trans care mgmt 7 day disch $231.36 $231.77 0.18% $197.67 $161.20 -18.45%