Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2000

This proposed rule would make several changes affecting Medicare Part B payment. The changes include: implementation of resource-based malpractice insurance relative value units (RVUs); refinement of resource-based practice expense RVUs; payment for physician pathology and independent laboratory services, RVUs related to ventricular assist devices, percutaneous thrombectomy of an arteriovenous fistula, pulse oximetry, temperature gradient studies, venous pressure determinations, and pulmonary stress testing; discontinuous anesthesia time; optometrist services; prostate screening; diagnostic tests; the use of an operating microscope; use of CPT modifier -25; qualifications for nurse practitioners; an increase in the work RVUs for pediatric services; removal of the x-ray as a prerequisite for chiropractic manipulation; the exclusion of payment for assisted suicide; adjustments to the practice expense RVUs for physician interpretation of Pap smears; and revisions to the work RVUs for new and revised CPT codes for calendar year 1999. In addition, since we established the physician fee schedule on January 1, 1992, our experience indicates that some of our Part B payment policies need to be reconsidered. This proposed rule would correct inequities in physician payment and solicits public comments on specific proposed policy changes.