As many of you know and have been preparing for, 2017 marks the start of the MACRA programs and the many changes and complexities that are to come with them. To keep you in the loop, we will be posting industry updates regarding MACRA and diagnostic imaging.
Regarding reimbursement, while the Medicare Physician Fee Schedule Rates for echocardiograms will remain mostly the same in 2017, there is one exception for transesophageal echocardiography (TEE).
TEE SEDATION MUST BE BILLED SEPARATELY
The biggest change to Medicare payment for echocardiography in 2017 is that payment for moderate sedation for TEE will not be included and must be billed separately under new CPT codes. We more commonly refer to moderate sedation as conscious sedation.
Moderate (or conscious) sedation is defined by CPT as drug-induced depression of consciousness in which the patient maintains the ability to purposefully respond to verbal commands (either alone or with light tactile stimulation). No interventions are necessary to maintain cardiovascular and airway function without support and spontaneous ventilation is adequate. If moderate sedation is not billed separately, payment will be lost.
NEW CPT CODES
These CPT codes are used with a TEE when the moderate sedation is provided by the same physician:
| CPT | Description | 2017 National Undadjusted PFS Rate (Non-hospital) | 2017 PFS National Unadjusted Rate (Hospital) |
|---|---|---|---|
| 99151 | Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intra-service time, patient younger than five years of age | $78.23 | $24.04 |
| 99152 | Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intra-service time, patient age 5 years or older | $52.04 | $12.56 |
| 99153 | Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; each additional 15 minutes of intra- service time (List separately in addition to code for primary service) | $11.12 | N/A |
Additional codes 99155, 99156 and 99157 are used when someone other than the physician performing the TEE performs the moderate sedation service.
RESOURCES
Please read more on the reimbursement changes from these ASE resources below:
