RI AAP Board Meeting Dates

6:00pm to 8:00pm
Hasbro Collis Room

Pediatric Grand Rounds Flyers

Location: Rhode Island Hosptial, George Auditorium
Fridays at 8:30 am

2011

Nov: November 2011 flyer.pdf

Featured Articles:

 

The U.S. Centers for Medicare and Medicaid Services (CMS) to reinstate payment for CPT code 96110.

 

The American Medical Association's CPT editorial panel recently changed code 96110 in status from a developmental test to a screen. Since Medicare does not pay for screening or preventive services unless authorized under the Medicare statute, CMS had initially determined that the code was ineligible for payment in Medicare. This decision was made during an annual review of all codes published by CMS in December 2011.

However, as a result of effective advocacy from AAP members from across the country, CMS recognized the consequences of such an action and published values for the code by listing its RVUs. This decision allows both Medicaid and plans in the private insurance market to continue using code 96110 even though it is technically not recognized for payment by the Medicare program.

In a recent Informational Bulletin, CMS stated: "We want to be clear that Medicaid and other private payers will be able to continue to use code 96110 even though it is a statutorily non-covered service under Medicare. In addition, many State Medicaid programs rely upon Medicare-published relative value units, including those associated with code 96110. At the request of Medicaid and concerned stakeholders, in the next few weeks Medicare will provide the relative value units for this code..."

Revised payment files to reflect corrections and revisions to the physician update amount will be posted on the Physician Fee Schedule portion of the CMS website in the near future. In the meantime, the payment rate for code 96110 will be based on 0.28 total RVUs (0.27 practice expense and 0.01 malpractice).