2016 Medicare Physician Final Fee Schedule Reimbursement...
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2016 Medicare Physician Final Fee Schedule Reimbursement & RVU Changes CPT/ HCPCS Mod Description 2016 Work RVUs 2015 Work RVUs 2016 Total Non-Facility RVUs 2015 Total Non-facility RVUs 2016 Total Facility RVUs 2015 Total Facility RVUs 2016 Medicare Payment (CF 35.8279) 2015 Medicare Payment (CF 35.9335) Percent Difference (Final 2016 vs. Final 2015) 43180 Esophagoscopy rigid trnso 9.03 9.03 NA NA 16.01 16.18 $573.60 $581.40 -1% 43191 Esophagoscopy rigid trnso dx 2.49 2.49 NA NA 4.49 4.45 $160.87 $159.90 1% 43192 Esophagoscp rig trnso inject 2.79 2.79 NA NA 4.95 4.94 $177.35 $177.51 0% 43193 Esophagoscp rig trnso biopsy 2.79 2.79 NA NA 4.94 4.93 $176.99 $177.15 0% 43194 Esophagoscp rig trnso rem fb 3.51 3.51 NA NA 5.62 5.56 $201.35 $199.79 1% 43195 Esophagoscopy rigid balloon 3.07 3.07 NA NA 5.37 5.39 $192.40 $193.68 -1% 43196 Esophagoscp guide wire dilat 3.31 3.31 NA NA 5.75 5.71 $206.01 $205.18 0% 43197 Esophagoscopy flex dx brush 1.52 1.52 5.41 5.39 2.41 2.40 $86.35 $86.24 0% 43198 Esophagosc flex trnsn biopsy 1.82 1.82 6.01 6.06 2.89 2.88 $103.54 $103.49 0% 43200 Esophagoscopy flexible brush 1.52 1.52 7.75 7.75 2.73 2.74 $97.81 $98.46 -1% 43201 Esoph scope w/submucous inj 1.82 1.82 7.88 7.92 3.19 3.22 $114.29 $115.71 -1% 43202 Esophagoscopy flex biopsy 1.82 1.82 10.32 10.4 3.19 3.23 $114.29 $116.07 -2% 43204 Esoph scope w/sclerosis inj 2.43 2.43 NA NA 4.12 4.22 $147.61 $151.64 -3% 43205 Esophagus endoscopy/ligation 2.54 2.54 NA NA 4.3 4.35 $154.06 $156.31 -1% 43206 Esoph optical endomicroscopy 2.39 2.39 9.4 9.46 4.12 4.11 $147.61 $147.69 0% 43211 Esophagoscop mucosal resect 4.3 4.3 NA NA 7.08 7.27 $253.66 $261.24 -3% 43212 Esophagoscop stent placement 3.5 3.5 NA NA 5.74 5.79 $205.65 $208.05 -1% 43213 Esophagoscopy retro balloon 4.73 4.73 34.81 35.34 7.73 7.85 $276.95 $282.08 -2% 43214 Esophagosc dilate balloon 30 3.5 3.5 NA NA 5.79 5.86 $207.44 $210.57 -1% 43215 Esophagoscopy flex remove fb 2.54 2.54 11.93 11.73 4.32 4.36 $154.78 $156.67 -1%
Transcript of 2016 Medicare Physician Final Fee Schedule Reimbursement...
2016 Medicare Physician Final Fee Schedule
Reimbursement & RVU Changes
CPT/
HCPCS Mod Description
2016
Work
RVUs
2015
Work
RVUs
2016 Total
Non-Facility
RVUs
2015 Total
Non-facility
RVUs
2016 Total
Facility
RVUs
2015 Total
Facility
RVUs
2016 Medicare
Payment (CF
35.8279)
2015 Medicare
Payment (CF
35.9335)
Percent
Difference
(Final 2016 vs.
Final 2015)
43180 Esophagoscopy rigid trnso 9.03 9.03 NA NA 16.01 16.18 $573.60 $581.40 -1%
43191 Esophagoscopy rigid trnso dx 2.49 2.49 NA NA 4.49 4.45 $160.87 $159.90 1%
43192 Esophagoscp rig trnso inject 2.79 2.79 NA NA 4.95 4.94 $177.35 $177.51 0%
43193 Esophagoscp rig trnso biopsy 2.79 2.79 NA NA 4.94 4.93 $176.99 $177.15 0%
43194 Esophagoscp rig trnso rem fb 3.51 3.51 NA NA 5.62 5.56 $201.35 $199.79 1%
43195 Esophagoscopy rigid balloon 3.07 3.07 NA NA 5.37 5.39 $192.40 $193.68 -1%
43196 Esophagoscp guide wire dilat 3.31 3.31 NA NA 5.75 5.71 $206.01 $205.18 0%
43197 Esophagoscopy flex dx brush 1.52 1.52 5.41 5.39 2.41 2.40 $86.35 $86.24 0%
43198 Esophagosc flex trnsn biopsy 1.82 1.82 6.01 6.06 2.89 2.88 $103.54 $103.49 0%
43200 Esophagoscopy flexible brush 1.52 1.52 7.75 7.75 2.73 2.74$97.81 $98.46 -1%
43201 Esoph scope w/submucous inj 1.82 1.82 7.88 7.92 3.19 3.22$114.29 $115.71 -1%
43202 Esophagoscopy flex biopsy 1.82 1.82 10.32 10.4 3.19 3.23 $114.29 $116.07 -2%
43204 Esoph scope w/sclerosis inj 2.43 2.43 NA NA 4.12 4.22 $147.61 $151.64 -3%
43205 Esophagus endoscopy/ligation 2.54 2.54 NA NA 4.3 4.35$154.06 $156.31 -1%
43206 Esoph optical endomicroscopy 2.39 2.39 9.4 9.46 4.12 4.11$147.61 $147.69 0%
43211 Esophagoscop mucosal resect 4.3 4.3 NA NA 7.08 7.27$253.66 $261.24 -3%
43212 Esophagoscop stent placement 3.5 3.5 NA NA 5.74 5.79$205.65 $208.05 -1%
43213 Esophagoscopy retro balloon 4.73 4.73 34.81 35.34 7.73 7.85 $276.95 $282.08 -2%
43214 Esophagosc dilate balloon 30 3.5 3.5 NA NA 5.79 5.86 $207.44 $210.57 -1%
43215 Esophagoscopy flex remove fb 2.54 2.54 11.93 11.73 4.32 4.36$154.78 $156.67 -1%
2016 Medicare Physician Final Fee Schedule
Reimbursement & RVU Changes
CPT/
HCPCS Mod Description
2016
Work
RVUs
2015
Work
RVUs
2016 Total
Non-Facility
RVUs
2015 Total
Non-facility
RVUs
2016 Total
Facility
RVUs
2015 Total
Facility
RVUs
2016 Medicare
Payment (CF
35.8279)
2015 Medicare
Payment (CF
35.9335)
Percent
Difference
(Final 2016 vs.
Final 2015)
43216 Esophagoscopy lesion removal 2.4 2.4 11.78 12.04 4.09 4.18$146.54 $150.20 -2%
43217 Esophagoscopy snare les remv 2.9 2.9 12.72 12.83 4.88 4.94$174.84 $177.51 -2%
43220 Esophagoscopy balloon <30mm 2.1 2.1 32.23 32.49 3.62 3.67$129.70 $131.88 -2%
43226 Esoph endoscopy dilation 2.34 2.34 10.84 10.91 4 4.04 $143.31 $145.17 -1%
43227 Esophagoscopy control bleed 2.99 2.99 19.77 11.33 5.01 5.09$179.50 $182.90 -2%
43229 Esophagoscopy lesion ablate 3.59 3.59 20.54 20.88 5.96 6.06 $213.53 $217.76 -2%
43231 Esophagoscop ultrasound exam 2.9 2.9 11.4 11.58 4.86 4.94$174.12 $177.51 -2%
43232 Esophagoscopy w/us needle bx 3.69 3.69 13.61 13.76 5.98 6.05$214.25 $217.40 -1%
43233 Egd balloon dil esoph30 mm/> 4.17 4.17 NA NA 6.85 6.91$245.42 $248.30 -1%
43235 Egd diagnostic brush wash 2.19 2.19 8.85 8.99 3.76 3.82 $134.71 $137.27 -2%
43236 Uppr gi scope w/submuc inj 2.49 2.49 11.01 11.2 4.23 4.30 $151.55 $154.51 -2%
43237 Endoscopic us exam esoph 3.57 3.57 NA NA 5.91 6.00 $211.74 $215.60 -2%
43238 Egd us fine needle bx/aspir 4.26 4.26 NA NA 7 7.14 $250.80 $256.57 -2%
43239 Egd biopsy single/multiple 2.49 2.49 11.29 11.48 4.22 4.29 $151.19 $154.15 -2%
43240 Egd w/transmural drain cyst 7.25 7.25 NA NA 11.71 11.89 $419.54 $427.25 -2%
43241 Egd tube/cath insertion 2.59 2.59 NA NA 4.34 4.40 $155.49 $158.11 -2%
43242 Egd us fine needle bx/aspir 4.83 4.83 NA NA 7.89 8.05 $282.68 $289.26 -2%
43243 Egd injection varices 4.37 4.37 NA NA 7.13 7.25 $255.45 $260.52 -2%
43244 Egd varices ligation 4.5 4.5 NA NA 7.38 7.52 $264.41 $270.22 -2%
43245 Egd dilate stricture 3.18 3.18 17.45 17.69 5.32 5.39 $190.60 $193.68 -2%
2016 Medicare Physician Final Fee Schedule
Reimbursement & RVU Changes
CPT/
HCPCS Mod Description
2016
Work
RVUs
2015
Work
RVUs
2016 Total
Non-Facility
RVUs
2015 Total
Non-facility
RVUs
2016 Total
Facility
RVUs
2015 Total
Facility
RVUs
2016 Medicare
Payment (CF
35.8279)
2015 Medicare
Payment (CF
35.9335)
Percent
Difference
(Final 2016 vs.
Final 2015)
43246 Egd place gastrostomy tube 3.66 3.66 NA NA 6.04 6.11 $216.40 $219.55 -1%
43247 Egd remove foreign body 3.21 3.21 11.83 11.71 5.37 5.45 $192.40 $195.84 -2%
43248 Egd guide wire insertion 3.01 3.01 11.61 11.83 5.04 5.14 $180.57 $184.70 -2%
43249 Esoph egd dilation <30 mm 2.77 2.77 30.52 31.03 4.67 4.75 $167.32 $170.68 -2%
43250 Egd cautery tumor polyp 3.07 3.07 12.96 13.13 5.15 5.22 $184.51 $187.57 -2%
43251 Egd remove lesion snare 3.57 3.57 14.19 14.42 5.93 6.02 $212.46 $216.32 -2%
43252 Egd optical endomicroscopy 3.06 3.06 10.45 10.59 5.1 5.21 $182.72 $187.21 -2%
43253 Egd us transmural injxn/mark 4.83 4.83 NA NA 7.87 8.05$281.97 $289.26 -3%
43254 Egd endo mucosal resection 4.97 4.97 NA NA 8.11 8.25 $290.56 $296.45 -2%
43255 Egd control bleeding any 3.66 3.66 20.74 12.4 6.06 6.17 $217.12 $221.71 -2%
43257 Egd w/thrml txmnt gerd 4.25 4.25 NA NA 7.01 7.11 $251.15 $255.49 -2%
43259 Egd us exam duodenum/jejunum 4.14 4.14 NA NA 6.81 6.93$243.99 $249.02 -2%
43260 Ercp w/specimen collection 5.95 5.95 NA NA 9.64 9.82 $345.38 $352.87 -2%
43261 Endo cholangiopancreatograph 6.25 6.25 NA NA 10.13 10.28$362.94 $369.40 -2%
43262 Endo cholangiopancreatograph 6.6 6.6 NA NA 10.67 10.85$382.28 $389.88 -2%
43263 Ercp sphincter pressure meas 6.6 6.6 NA NA 10.69 10.88$383.00 $390.96 -2%
43264 Ercp remove duct calculi 6.73 6.73 NA NA 10.87 11.06 $389.45 $397.42 -2%
43265 Ercp lithotripsy calculi 8.03 8.03 NA NA 12.92 13.12 $462.90 $471.45 -2%
43266 Egd endoscopic stent place 4.17 4.17 NA NA 6.81 6.92 $243.99 $248.66 -2%
43270 Egd lesion ablation 4.26 4.26 21.36 21.75 7 7.13 $250.80 $256.21 -2%
43273 Endoscopic pancreatoscopy 2.24 2.24 NA NA 3.52 3.58 $126.11 $128.64 -2%
43274 Ercp duct stent placement 8.58 8.58 NA NA 13.79 14.00 $494.07 $503.07 -2%
2016 Medicare Physician Final Fee Schedule
Reimbursement & RVU Changes
CPT/
HCPCS Mod Description
2016
Work
RVUs
2015
Work
RVUs
2016 Total
Non-Facility
RVUs
2015 Total
Non-facility
RVUs
2016 Total
Facility
RVUs
2015 Total
Facility
RVUs
2016 Medicare
Payment (CF
35.8279)
2015 Medicare
Payment (CF
35.9335)
Percent
Difference
(Final 2016 vs.
Final 2015)
43275 Ercp remove forgn body duct 6.96 6.96 NA NA 11.24 11.42 $402.71 $410.36 -2%
43276 Ercp stent exchange w/dilate 8.94 8.94 NA NA 14.35 14.57 $514.13 $523.55 -2%
43277 Ercp ea duct/ampulla dilate 7 7 NA NA 11.3 11.48 $404.86 $412.52 -2%
43278 Ercp lesion ablate w/dilate 8.02 8.02 NA NA 12.91 13.11 $462.54 $471.09 -2%
44322 Colostomy with biopsies 13.32 13.32 NA NA 28.97 28.92 $1,037.93 $1,039.20 0%
44340 Revision of colostomy 9.28 9.28 NA NA 18.15 18.05 $650.28 $648.60 0%
44345 Revision of colostomy 17.22 17.22 NA NA 30.55 30.43 $1,094.54 $1,093.46 0%
44346 Revision of colostomy 19.63 19.63 NA NA 34.35 34.22 $1,230.69 $1,229.64 0%
44360 Small bowel endoscopy 2.59 2.59 NA NA 4.38 4.45 $156.93 $159.90 -2%
44361 Small bowel endoscopy/biopsy 2.87 2.87 NA NA 4.83 4.91$173.05 $176.43 -2%
44363 Small bowel endoscopy 3.49 3.49 NA NA 5.79 5.88 $207.44 $211.29 -2%
44364 Small bowel endoscopy 3.73 3.73 NA NA 6.16 6.27 $220.70 $225.30 -2%
44365 Small bowel endoscopy 3.31 3.31 NA NA 5.42 5.46 $194.19 $196.20 -1%
44366 Small bowel endoscopy 4.4 4.4 NA NA 7.22 7.36 $258.68 $264.47 -2%
44369 Small bowel endoscopy 4.51 4.51 NA NA 7.39 7.53 $264.77 $270.58 -2%
44370 Small bowel endoscopy/stent 4.79 4.79 NA NA 8 8.14$286.62 $292.50 -2%
44372 Small bowel endoscopy 4.4 4.4 NA NA 7.22 7.33 $258.68 $263.39 -2%
44373 Small bowel endoscopy 3.49 3.49 NA NA 5.8 5.88 $207.80 $211.29 -2%
44376 Small bowel endoscopy 5.25 5.25 NA NA 8.51 8.62 $304.90 $309.75 -2%
44377 Small bowel endoscopy/biopsy 5.52 5.52 NA NA 8.98 9.13$321.73 $328.07 -2%
44378 Small bowel endoscopy 7.12 7.12 NA NA 11.48 11.68 $411.30 $419.70 -2%
44379 S bowel endoscope w/stent 7.46 7.46 NA NA 12.23 12.44 $438.18 $447.01 -2%
44380 Small bowel endoscopy br/wa 0.97 1.05 6.26 NA 1.81 1.96$64.85 $70.43 -8%
2016 Medicare Physician Final Fee Schedule
Reimbursement & RVU Changes
CPT/
HCPCS Mod Description
2016
Work
RVUs
2015
Work
RVUs
2016 Total
Non-Facility
RVUs
2015 Total
Non-facility
RVUs
2016 Total
Facility
RVUs
2015 Total
Facility
RVUs
2016 Medicare
Payment (CF
35.8279)
2015 Medicare
Payment (CF
35.9335)
Percent
Difference
(Final 2016 vs.
Final 2015)
44381 Small bowel endoscopy br/wa 1.48 0 28.41 0 2.65 0.00$94.94 $0.00 NA
44382 Small bowel endoscopy 1.27 1.27 9.09 NA 2.3 2.33 $82.40 $83.73 -2%
44384 Small bowel endoscopy 2.95 0 NA 0 4.59 0.00 $164.45 $0.00 NA
44385 Endoscopy of bowel pouch 1.3 1.82 6.91 7.58 2.24 3.10 $80.25 $111.39 -28%
44386 Endoscopy bowel pouch/biop 1.6 2.12 9.73 10.1 2.77 3.66$99.24 $131.52 -25%
44388 Colonoscopy thru stoma spx 2.82 2.82 10.04 10.06 4.75 4.80 $170.18 $172.48 -1%
44388 53 Colonoscopy thru stoma spx 1.41 NA 4.98 NA 2.34 NA $83.84 NA NA
44389 Colonoscopy with biopsy 3.12 3.13 12.66 11.27 5.21 5.30 $186.66 $190.45 -2%
44390 Colonoscopy for foreign body 3.84 3.82 12.64 13.21 6.35 6.45$227.51 $231.77 -2%
44391 Colonoscopy for bleeding 4.22 4.31 21.8 14.2 6.94 7.20 $248.65 $258.72 -4%
44392 Colonoscopy & polypectomy 3.63 3.81 11.89 12.52 5.98 6.28 $214.25 $225.66 -5%
44394 Colonoscopy w/snare 4.13 4.42 13.4 14.15 6.79 7.35 $243.27 $264.11 -8%
44401 Colonoscopy with ablation 4.44 0 92.54 0 7.28 0.00 $260.83 $0.00 NA
44402 Colonoscopy w/stent plcmt 4.8 0 NA 0 7.89 0.00 $282.68 $0.00 NA
44403 Colonoscopy w/resection 5.6 0 NA 0 9.05 0.00 $324.24 $0.00 NA
44404 Colonoscopy w/injection 3.12 0 12.13 0 5.22 0.00 $187.02 $0.00 NA
44405 Colonoscopy w/dilation 3.33 0 17.39 0 5.55 0.00 $198.84 $0.00 NA
44406 Colonoscopy w/ultrasound 4.2 0 NA 0 6.91 0.00 $247.57 $0.00 NA
44407 Colonoscopy w/ndl aspir/bx 5.06 0 NA 0 8.27 0.00 $296.30 $0.00 NA
44408 Colonoscopy w/decompression 4.24 0 NA 0 6.98 0.00$250.08 $0.00 NA
44500 Intro gastrointestinal tube 0.49 0.49 NA NA 0.71 0.71 $25.44 $25.51 0%
45300 Proctosigmoidoscopy dx 0.8 0.8 3.5 3.53 1.56 1.56 $55.89 $56.06 0%
45303 Proctosigmoidoscopy dilate 1.5 1.5 27.33 27.58 2.68 2.69 $96.02 $96.66 -1%
2016 Medicare Physician Final Fee Schedule
Reimbursement & RVU Changes
CPT/
HCPCS Mod Description
2016
Work
RVUs
2015
Work
RVUs
2016 Total
Non-Facility
RVUs
2015 Total
Non-facility
RVUs
2016 Total
Facility
RVUs
2015 Total
Facility
RVUs
2016 Medicare
Payment (CF
35.8279)
2015 Medicare
Payment (CF
35.9335)
Percent
Difference
(Final 2016 vs.
Final 2015)
45305 Proctosigmoidoscopy w/bx 1.25 1.25 5.55 5.58 2.27 2.29 $81.33 $82.29 -1%
45307 Proctosigmoidoscopy fb 1.7 1.7 6.66 6.39 3.08 2.97 $110.35 $106.72 3%
45308 Proctosigmoidoscopy removal 1.4 1.4 6.14 6.28 2.58 2.59$92.44 $93.07 -1%
45309 Proctosigmoidoscopy removal 1.5 1.5 6.44 6.32 2.75 2.61$98.53 $93.79 5%
45315 Proctosigmoidoscopy removal 1.8 1.8 6.43 7.1 3.03 3.25$108.56 $116.78 -7%
45317 Proctosigmoidoscopy bleed 2 2 6.94 6.93 3.41 3.40 $122.17 $122.17 0%
45320 Proctosigmoidoscopy ablate 1.78 1.78 6.94 7.01 3.2 3.21 $114.65 $115.35 -1%
45321 Proctosigmoidoscopy volvul 1.75 1.75 NA NA 3.11 3.10 $111.42 $111.39 0%
45327 Proctosigmoidoscopy w/stent 2 2 NA NA 3.54 3.54$126.83 $127.20 0%
45330 Diagnostic sigmoidoscopy 0.84 0.96 4.74 3.91 1.63 1.83 $58.40 $65.76 -11%
45331 Sigmoidoscopy and biopsy 1.14 1.15 7.28 4.64 2.11 2.16 $75.60 $77.62 -3%
45332 Sigmoidoscopy w/fb removal 1.86 1.79 8.83 8.32 3.25 3.18$116.44 $114.27 2%
45333 Sigmoidoscopy & polypectomy 1.65 1.79 9.91 8.46 2.91 3.17$104.26 $113.91 -8%
45334 Sigmoidoscopy for bleeding 2.1 2.73 17.32 NA 3.61 4.68 $129.34 $168.17 -23%
45335 Sigmoidoscopy w/submuc inj 1.14 1.46 8.21 7.83 2.1 2.65$75.24 $95.22 -21%
45337 Sigmoidoscopy & decompress 2.2 2.36 NA NA 3.54 4.09$126.83 $146.97 -14%
45338 Sigmoidoscopy w/tumr remove 2.15 2.34 9.22 9.08 3.69 4.04$132.20 $145.17 -9%
45340 Sig w/tndsc balloon dilation 1.35 1.89 13.92 13.86 2.44 3.33 $87.42 $119.66 -27%
2016 Medicare Physician Final Fee Schedule
Reimbursement & RVU Changes
CPT/
HCPCS Mod Description
2016
Work
RVUs
2015
Work
RVUs
2016 Total
Non-Facility
RVUs
2015 Total
Non-facility
RVUs
2016 Total
Facility
RVUs
2015 Total
Facility
RVUs
2016 Medicare
Payment (CF
35.8279)
2015 Medicare
Payment (CF
35.9335)
Percent
Difference
(Final 2016 vs.
Final 2015)
45341 Sigmoidoscopy w/ultrasound 2.22 2.6 NA NA 3.8 4.46$136.15 $160.26 -15%
45342 Sigmoidoscopy w/us guide bx 3.08 4.05 NA NA 5.15 6.77$184.51 $243.27 -24%
45346 Sigmoidoscopy w/ablation 2.91 0 88.64 0 4.86 0.00 $174.12 $0.00 NA
45347 Sigmoidoscopy w/plcmt stent 2.82 0 NA 0 4.69 0.00$168.03 $0.00 NA
45349 Sigmoidoscopy w/resection 3.62 0 NA 0 5.98 0.00 $214.25 $0.00 NA
45350 Sgmdsc w/band ligation 1.78 0 16.58 0 3.1 0.00 $111.07 $0.00 NA
45378 Diagnostic colonoscopy 3.36 3.69 10.78 11.06 5.59 6.19 $200.28 $222.43 -10%
45378 53 Diagnostic colonoscopy 1.68 0.96 5.38 3.91 2.79 1.83 $99.96 $65.76 52%
45379 Colonoscopy w/fb removal 4.38 4.68 13.6 14.25 7.19 7.78 $257.60 $279.56 -8%
45380 Colonoscopy and biopsy 3.66 4.43 13.33 13.18 6.06 7.40 $217.12 $265.91 -18%
45381 Colonoscopy submucous njx 3.66 4.19 12.82 13.24 6.05 7.01 $216.76 $251.89 -14%
45382 Colonoscopy w/control bleed 4.76 5.68 22.55 17.12 7.78 9.39$278.74 $337.42 -17%
45384 Colonoscopy w/lesion removal 4.17 4.69 14.63 13.21 6.87 7.76$246.14 $278.84 -12%
45385 Colonoscopy w/lesion removal 4.67 5.3 13.98 14.88 7.65 8.78$274.08 $315.50 -13%
45386 Colonoscopy w/balloon dilat 3.87 4.57 18.63 18.96 6.39 7.60 $228.94 $273.09 -16%
45388 Colonoscopy w/ablation 4.98 0 93.1 0 8.12 0.00 $290.92 $0.00 NA
45389 Colonoscopy w/stent plcmt 5.34 0 NA 0 8.69 0.00 $311.34 $0.00 NA
45390 Colonoscopy w/resection 6.14 0 NA 0 9.92 0.00 $355.41 $0.00 NA
45391 Colonoscopy w/endoscope us 4.74 5.09 NA NA 7.73 8.43$276.95 $302.92 -9%
2016 Medicare Physician Final Fee Schedule
Reimbursement & RVU Changes
CPT/
HCPCS Mod Description
2016
Work
RVUs
2015
Work
RVUs
2016 Total
Non-Facility
RVUs
2015 Total
Non-facility
RVUs
2016 Total
Facility
RVUs
2015 Total
Facility
RVUs
2016 Medicare
Payment (CF
35.8279)
2015 Medicare
Payment (CF
35.9335)
Percent
Difference
(Final 2016 vs.
Final 2015)
45392 Colonoscopy w/endoscopic fnb 5.6 6.54 NA NA 9.11 10.73$326.39 $385.57 -15%
45393 Colonoscopy w/decompression 4.78 0 NA 0 7.59 0.00$271.93 $0.00 NA
45395 Lap removal of rectum 33 33 NA NA 57.43 57.35 $2,057.60 $2,060.79 0%
45397 Lap remove rectum w/pouch 36.5 36.5 NA NA 62.54 62.45 $2,240.68 $2,244.05 0%
45398 Colonoscopy w/band ligation 4.3 0 20.82 0 7.07 0.00$253.30 $0.00 NA
45900 Reduction of rectal prolapse 2.99 2.99 NA NA 5.88 5.90 $210.67 $212.01 -1%
45905 Dilation of anal sphincter 2.35 2.35 NA NA 4.91 4.89 $175.91 $175.71 0%
45910 Dilation of rectal narrowing 2.85 2.85 NA NA 5.62 5.62 $201.35 $201.95 0%
45915 Remove rectal obstruction 3.19 3.19 9.47 9.49 6.52 6.55 $233.60 $235.36 -1%
46083 Incise external hemorrhoid 1.45 1.45 5.01 5.02 3.06 3.06 $109.63 $109.96 0%
46200 Removal of anal fissure 3.59 3.59 12.71 12.79 9.35 9.37 $334.99 $336.70 -1%
46220 Excise anal ext tag/papilla 1.61 1.61 5.89 5.9 3.43 3.43 $122.89 $123.25 0%
46221 Ligation of hemorrhoid(s) 2.36 2.36 7.66 7.73 5.47 5.53 $195.98 $198.71 -1%
46230 Removal of anal tags 2.62 2.62 7.8 7.81 4.98 4.99 $178.42 $179.31 0%
46250 Remove ext hem groups 2+ 4.25 4.25 13.29 13.27 9.11 9.06 $326.39 $325.56 0%
46255 Remove int/ext hem 1 group 4.96 4.96 14.53 14.54 10.23 10.19 $366.52 $366.16 0%
46257 Remove in/ex hem grp & fiss 5.76 5.76 NA NA 12.18 12.12 $436.38 $435.51 0%
46258 Remove in/ex hem grp w/fistu 6.41 6.41 NA NA 13.49 13.43$483.32 $482.59 0%
46260 Remove in/ex hem groups 2+ 6.73 6.73 NA NA 13.75 13.71$492.63 $492.65 0%
46261 Remove in/ex hem grps & fiss 7.76 7.76 NA NA 15.09 15.01$540.64 $539.36 0%
2016 Medicare Physician Final Fee Schedule
Reimbursement & RVU Changes
CPT/
HCPCS Mod Description
2016
Work
RVUs
2015
Work
RVUs
2016 Total
Non-Facility
RVUs
2015 Total
Non-facility
RVUs
2016 Total
Facility
RVUs
2015 Total
Facility
RVUs
2016 Medicare
Payment (CF
35.8279)
2015 Medicare
Payment (CF
35.9335)
Percent
Difference
(Final 2016 vs.
Final 2015)
46262 Remove in/ex hem grps w/fist 7.91 7.91 NA NA 15.93 15.96$570.74 $573.50 0%
46270 Remove anal fist subq 4.92 4.92 14.59 14.57 11.33 11.28 $405.93 $405.33 0%
46275 Remove anal fist inter 5.42 5.42 15.43 15.45 11.94 11.92 $427.79 $428.33 0%
46280 Remove anal fist complex 6.39 6.39 NA NA 13.55 13.53 $485.47 $486.18 0%
46285 Remove anal fist 2 stage 5.42 5.42 15.29 15.3 11.91 11.87 $426.71 $426.53 0%
46288 Repair anal fistula 7.81 7.81 NA NA 15.89 15.86 $569.31 $569.91 0%
46320 Removal of hemorrhoid clot 1.64 1.64 5.23 5.25 3.2 3.20 $114.65 $114.99 0%
46500 Injection into hemorrhoid(s) 1.42 1.69 5.54 6.85 3.55 3.73 $127.19 $134.03 -5%
46505 Chemodenervation anal musc 3.18 3.18 8.17 8.15 6.88 6.86$246.50 $246.50 0%
46600 Diagnostic anoscopy spx 0.55 0.55 2.52 2.52 1.18 1.17 $42.28 $42.04 1%
46601 Diagnostic anoscopy 1.6 0 3.9 0 2.7 0.00 $96.74 $0.00 NA
46604 Anoscopy and dilation 1.03 1.03 17.62 17.86 1.92 1.92 $68.79 $68.99 0%
46606 Anoscopy and biopsy 1.2 1.2 6.43 6.43 2.2 2.20 $78.82 $79.05 0%
46607 Diagnostic anoscopy & biopsy 2.2 0 5.44 0 3.64 0.00$130.41 $0.00 NA
46608 Anoscopy remove for body 1.3 1.3 6.61 6.79 2.34 2.44 $83.84 $87.68 -4%
46610 Anoscopy remove lesion 1.28 1.28 6.43 6.46 2.34 2.36 $83.84 $84.80 -1%
46611 Anoscopy 1.3 1.3 5 4.99 2.35 2.36 $84.20 $84.80 -1%
46612 Anoscopy remove lesions 1.5 1.5 7.33 7.85 2.7 2.76 $96.74 $99.18 -2%
46614 Anoscopy control bleeding 1 1 3.65 3.68 1.87 1.87 $67.00 $67.20 0%
46615 Anoscopy 1.5 1.5 4.11 4.13 2.68 2.69 $96.02 $96.66 -1%
74235 26 Remove esophagus obstruction 0 1.19 0 1.8 NA 1.80NA $64.68 NA
74261 26 Ct colonography dx 2.4 2.4 3.43 3.45 3.43 3.45 $122.89 $123.97 -1%
74262 26 Ct colonography dx w/dye 2.5 2.5 3.57 3.59 3.57 3.59 $127.91 $129.00 -1%
2016 Medicare Physician Final Fee Schedule
Reimbursement & RVU Changes
CPT/
HCPCS Mod Description
2016
Work
RVUs
2015
Work
RVUs
2016 Total
Non-Facility
RVUs
2015 Total
Non-facility
RVUs
2016 Total
Facility
RVUs
2015 Total
Facility
RVUs
2016 Medicare
Payment (CF
35.8279)
2015 Medicare
Payment (CF
35.9335)
Percent
Difference
(Final 2016 vs.
Final 2015)
74263 26 Ct colonography screening 2.28 2.28 3.22 3.24 3.22 3.24 $115.37 $116.42 -1%
78258 Esophageal motility study 0.74 0.74 6.44 6.38 NA NA NA NA NA
78258 TC Esophageal motility study 0 0 5.4 5.36 NA NA NA NA NA
78258 26 Esophageal motility study 0.74 0.74 6.44 1.02 NA 1.02 NA $36.65 NA
78261 26 Gastric mucosa imaging 0.69 0.69 7.22 0.99 NA 0.99 NA $35.57 NA
78262 26 Gastroesophageal reflux exam 0.68 0.68 7.1 0.94 NA 0.94NA $33.78 NA
78264 26 Gastric emptying study 0.74 0.8 1.04 1.12 1.04 1.12 $37.26 $40.25 -7%
88302 26 Tissue exam by pathologist 0.13 0.13 0.92 0.2 NA 0.20 NA $7.19 NA
88304 26 Tissue exam by pathologist 0.22 0.22 0.33 0.33 0.33 0.33 $11.82 $11.86 0%
88305 Tissue exam by pathologist 0.75 0.75 2.07 2.04 NA NA NA NA NA
88305 TC Tissue exam by pathologist 0.75 0 1.11 0.95 1.11 NA $39.77 NA NA
88305 26 Tissue exam by pathologist 0.75 0.75 1.11 1.09 1.11 1.09 $39.77 $39.17 2%
91010 Esophagus motility study 1.28 1.28 4.97 5.03 NA NA NA NA NA
91010 TC Esophagus motility study 1.28 0 1.91 3.09 1.91 NA $68.43 NA NA
91010 26 Esophagus motility study 1.28 1.28 1.91 1.94 1.91 1.94 $68.43 $69.71 -2%
91013 Esophgl motil w/stim/perfus 0.18 0.18 0.66 0.68 NA NA NA NA NA
91013 TC Esophgl motil w/stim/perfus 0 0 0.39 0.41 NA NA NA NA NA
91013 26 Esophgl motil w/stim/perfus 0.18 0.18 0.66 0.27 NA 0.27 NA $9.70 NA
91020 Gastric motility studies 1.44 1.44 6.61 6.63 NA NA NA NA NA
91020 TC Gastric motility studies 0 0 4.47 4.49 NA NA NA NA NA
91020 26 Gastric motility studies 1.44 1.44 6.61 2.14 NA 2.14 NA $76.90 NA
91022 Duodenal motility study 1.44 1.44 4.73 4.82 NA NA NA NA NA
91022 TC Duodenal motility study 0 0 2.59 2.67 NA NA NA NA NA
91022 26 Duodenal motility study 1.44 1.44 4.73 2.15 NA 2.15 NA $77.26 NA
91030 Acid perfusion of esophagus 0.91 0.91 3.84 3.89 NA NA NA NA NA
91030 TC Acid perfusion of esophagus 0.91 0 1.34 2.54 1.34 NA $48.01 NA NA
2016 Medicare Physician Final Fee Schedule
Reimbursement & RVU Changes
CPT/
HCPCS Mod Description
2016
Work
RVUs
2015
Work
RVUs
2016 Total
Non-Facility
RVUs
2015 Total
Non-facility
RVUs
2016 Total
Facility
RVUs
2015 Total
Facility
RVUs
2016 Medicare
Payment (CF
35.8279)
2015 Medicare
Payment (CF
35.9335)
Percent
Difference
(Final 2016 vs.
Final 2015)
91030 26 Acid perfusion of esophagus 0.91 0.91 1.34 1.35 1.34 1.35 $48.01 $48.51 -1%
91034 Gastroesophageal reflux test 0.97 0.97 5.35 5.32 NA NA NA NA NA
91034 TC Gastroesophageal reflux test 0.97 0 1.46 3.89 1.46 NA $52.31 NA NA
91034 26 Gastroesophageal reflux test 0.97 0.97 1.46 1.43 1.46 1.43 $52.31 $51.38 2%
91035 G-esoph reflx tst w/electrod 1.59 1.59 13.57 13.7 NA NA NA NA NA
91035 TC G-esoph reflx tst w/electrod 1.59 0 2.39 11.32 2.39 NA $85.63 NA NA
91035 26 G-esoph reflx tst w/electrod 1.59 1.59 2.39 2.38 2.39 2.38 $85.63 $85.52 0%
91037 Esoph imped function test 0.97 0.97 4.52 4.58 NA NA NA NA NA
91037 TC Esoph imped function test 0.97 0 1.44 3.12 1.44 NA $51.59 NA NA
91037 26 Esoph imped function test 0.97 0.97 1.44 1.46 1.44 1.46 $51.59 $52.46 -2%
91038 Esoph imped funct test > 1hr 1.1 1.1 12.7 12.89 NA NA NA NA NA
91038 TC Esoph imped funct test > 1hr 0 0 11.06 11.21 NA NA NA NA NA
91038 26 Esoph imped funct test > 1hr 1.1 1.1 12.7 1.68 NA 1.68 NA $60.37 NA
91040 Esoph balloon distension tst 0.97 0.97 12.25 12.45 NA NA NA NA NA
91040 TC Esoph balloon distension tst 0 0 10.83 11.01 NA NA NA NA NA
91040 26 Esoph balloon distension tst 0.97 0.97 12.25 1.44 NA 1.44 NA $51.74 NA
91065 Breath hydrogen/methane test 0.2 0.2 2.21 2.3 NA NANA NA NA
91065 TC Breath hydrogen/methane test 0 0 1.92 2 NA NANA NA NA
91065 26 Breath hydrogen/methane test 0.2 0.2 2.21 0.3 NA 0.30NA $10.78 NA
91110 Gi tract capsule endoscopy 3.64 3.64 24.92 25.31 NA NA NA NA NA
91110 TC Gi tract capsule endoscopy 3.64 0 5.41 19.85 5.41 NA $193.83 NA NA
91110 26 Gi tract capsule endoscopy 3.64 3.64 5.41 5.46 5.41 5.46 $193.83 $196.20 -1%
91111 Esophageal capsule endoscopy 1 1 20.45 20.76 NA NANA NA NA
2016 Medicare Physician Final Fee Schedule
Reimbursement & RVU Changes
CPT/
HCPCS Mod Description
2016
Work
RVUs
2015
Work
RVUs
2016 Total
Non-Facility
RVUs
2015 Total
Non-facility
RVUs
2016 Total
Facility
RVUs
2015 Total
Facility
RVUs
2016 Medicare
Payment (CF
35.8279)
2015 Medicare
Payment (CF
35.9335)
Percent
Difference
(Final 2016 vs.
Final 2015)
91111 TC Esophageal capsule endoscopy 1 0 1.49 19.27 1.49 NA$53.38 NA NA
91111 26 Esophageal capsule endoscopy 1 1 1.49 1.49 1.49 1.49$53.38 $53.54 0%
91112 Gi wireless capsule measure 2.1 2.1 30.51 30.79 NA NA NA NA NA
91112 TC Gi wireless capsule measure 2.1 0 3.12 27.64 3.12 NA $111.78 NA NA
91112 26 Gi wireless capsule measure 2.1 2.1 3.12 3.15 3.12 3.15 $111.78 $113.19 -1%
91117 Colon motility 6 hr study 2.45 2.45 NA NA 3.94 4.02 $141.16 $144.45 -2%
91120 Rectal sensation test 0.97 0.97 12.01 12.2 NA NA NA NA NA
91120 TC Rectal sensation test 0 0 10.58 10.74 NA NA NA NA NA
91120 26 Rectal sensation test 0.97 0.97 12.01 1.46 NA 1.46 NA $52.46 NA
91122 Anal pressure record 1.77 1.77 6.41 6.38 NA NA NA NA NA
91122 TC Anal pressure record 0 0 3.84 3.83 NA NA NA NA NA
91122 26 Anal pressure record 1.77 1.77 6.41 2.55 NA 2.55 NA $91.63 NA
91132 Electrogastrography 0.52 0.52 4.36 4.22 NA NA NA NA NA
91132 TC Electrogastrography 0.52 0 0.8 3.44 0.8 NA $28.66 NA NA
91132 26 Electrogastrography 0.52 0.52 0.8 0.78 0.8 0.78 $28.66 $28.03 2%
91133 Electrogastrography w/test 0.66 0.66 4.85 4.89 NA NA NA NA NA
91133 TC Electrogastrography w/test 0.66 0 0.98 3.91 0.98 NA $35.11 NA NA
91133 26 Electrogastrography w/test 0.66 0.66 0.98 0.98 0.98 0.98 $35.11 $35.21 0%
91200 Liver elastography 0.27 0.3 0.8 1.01 NA NA NA NA NA
91200 TC Liver elastography 0 0 0.43 0.6 NA NA NA NA NA
91200 26 Liver elastography 0.27 0.3 0.8 0.41 NA 0.41 NA $14.73 NA
91299 Gastroenterology procedure 0 0 0 0 NA NA NA NA NA
91299 TC Gastroenterology procedure 0 0 0 0 NA NA NA NA NA
91299 26 Gastroenterology procedure 0 0 0 0 NA 0.00 NA $0.00 NA
2016 Medicare Physician Final Fee Schedule
Reimbursement & RVU Changes
CPT/
HCPCS Mod Description
2016
Work
RVUs
2015
Work
RVUs
2016 Total
Non-Facility
RVUs
2015 Total
Non-facility
RVUs
2016 Total
Facility
RVUs
2015 Total
Facility
RVUs
2016 Medicare
Payment (CF
35.8279)
2015 Medicare
Payment (CF
35.9335)
Percent
Difference
(Final 2016 vs.
Final 2015)
92610 Evaluate swallowing function 1.3 1.3 2.41 2.39 2.06 2.05$73.81 $73.66 0%
92611 Motion fluoroscopy/swallow 1.34 1.34 2.46 2.44 NA NA NA NA NA
92612 Endoscopy swallow tst (fees) 1.27 1.27 5.27 4.88 1.94 1.93 $69.51 $69.35 0%
92613 Endoscopy swallow tst (fees) 0.71 0.71 1.09 1.09 1.09 1.09 $39.05 $39.17 0%
93615 Esophageal recording 0 0 0 0 NA NA NA NA NA
93615 TC Esophageal recording 0 0 0 0 NA NA NA NA NA
93615 26 Esophageal recording 0 0.99 0 1.48 NA 1.48 NA $53.18 NA
93616 Esophageal recording 0 0 0 0 NA NA NA NA NA
93616 TC Esophageal recording 1.49 0 1.86 0 1.86 NA $66.64 NA NA
93616 26 Esophageal recording 1.49 1.49 1.86 1.85 1.86 1.85 $66.64 $66.48 0%
95980 Io anal gast n-stim init 0.8 0.8 NA NA 1.32 1.31 $47.29 $47.07 0%
95981 Io anal gast n-stim subsq 0.3 0.3 0.9 0.9 0.51 0.50 $18.27 $17.97 2%
99201 Office/outpatient visit new 0.48 0.48 1.24 1.23 0.76 0.75 $27.23 $26.95 1%
99202 Office/outpatient visit new 0.93 0.93 2.11 2.1 1.42 1.41 $50.88 $50.67 0%
99203 Office/outpatient visit new 1.42 1.42 3.05 3.05 2.17 2.17 $77.75 $77.98 0%
99204 Office/outpatient visit new 2.43 2.43 4.64 4.64 3.67 3.67 $131.49 $131.88 0%
99205 Office/outpatient visit new 3.17 3.17 5.82 5.83 4.77 4.77 $170.90 $171.40 0%
99211 Office/outpatient visit est 0.18 0.18 0.56 0.56 0.26 0.26 $9.32 $9.34 0%
99212 Office/outpatient visit est 0.48 0.48 1.23 1.23 0.72 0.72 $25.80 $25.87 0%
99213 Office/outpatient visit est 0.97 0.97 2.05 2.04 1.44 1.43 $51.59 $51.38 0%
99214 Office/outpatient visit est 1.5 1.5 3.02 3.03 2.21 2.21 $79.18 $79.41 0%
99215 Office/outpatient visit est 2.11 2.11 4.07 4.09 3.12 3.14 $111.78 $112.83 -1%
99217 Observation care discharge 1.28 1.28 NA NA 2.05 2.05 $73.45 $73.66 0%
99218 Initial observation care 1.92 1.92 NA NA 2.81 2.83 $100.68 $101.69 -1%
99219 Initial observation care 2.6 2.6 NA NA 3.81 3.83 $136.50 $137.63 -1%
99220 Initial observation care 3.56 3.56 NA NA 5.22 5.25 $187.02 $188.65 -1%
2016 Medicare Physician Final Fee Schedule
Reimbursement & RVU Changes
CPT/
HCPCS Mod Description
2016
Work
RVUs
2015
Work
RVUs
2016 Total
Non-Facility
RVUs
2015 Total
Non-facility
RVUs
2016 Total
Facility
RVUs
2015 Total
Facility
RVUs
2016 Medicare
Payment (CF
35.8279)
2015 Medicare
Payment (CF
35.9335)
Percent
Difference
(Final 2016 vs.
Final 2015)
99221 Initial hospital care 1.92 1.92 NA NA 2.86 2.87 $102.47 $103.13 -1%
99222 Initial hospital care 2.61 2.61 NA NA 3.86 3.87 $138.30 $139.06 -1%
99223 Initial hospital care 3.86 3.86 NA NA 5.7 5.73 $204.22 $205.90 -1%
99224 Subsequent observation care 0.76 0.76 NA NA 1.12 1.11$40.13 $39.89 1%
99225 Subsequent observation care 1.39 1.39 NA NA 2.05 2.05$73.45 $73.66 0%
99226 Subsequent observation care 2 2 NA NA 2.95 2.97$105.69 $106.72 -1%
99231 Subsequent hospital care 0.76 0.76 NA NA 1.11 1.10 $39.77 $39.53 1%
99232 Subsequent hospital care 1.39 1.39 NA NA 2.03 2.04 $72.73 $73.30 -1%
99233 Subsequent hospital care 2 2 NA NA 2.93 2.94 $104.98 $105.64 -1%
99234 Observ/hosp same date 2.56 2.56 NA NA 3.76 3.78 $134.71 $135.83 -1%
99235 Observ/hosp same date 3.24 3.24 NA NA 4.76 4.77 $170.54 $171.40 -1%
99236 Observ/hosp same date 4.2 4.2 NA NA 6.13 6.15 $219.63 $220.99 -1%
99238 Hospital discharge day 1.28 1.28 NA NA 2.04 2.06 $73.09 $74.02 -1%
99239 Hospital discharge day 1.9 1.9 NA NA 3.02 3.03 $108.20 $108.88 -1%
99241 Office consultation 0.64 0.64 1.34 1.37 0.92 0.95 $32.96 $34.14 -3%
99242 Office consultation 1.34 1.34 2.52 2.57 1.93 1.98 $69.15 $71.15 -3%
99243 Office consultation 1.88 1.88 3.45 3.51 2.7 2.76 $96.74 $99.18 -2%
99244 Office consultation 3.02 3.02 5.16 5.19 4.34 4.37 $155.49 $157.03 -1%
99245 Office consultation 3.77 3.77 6.29 6.35 5.37 5.43 $192.40 $195.12 -1%
99251 Inpatient consultation 1 1 NA NA 1.38 1.39 $49.44 $49.95 -1%
99252 Inpatient consultation 1.5 1.5 NA NA 2.11 2.13 $75.60 $76.54 -1%
99253 Inpatient consultation 2.27 2.27 NA NA 3.24 3.25 $116.08 $116.78 -1%
99254 Inpatient consultation 3.29 3.29 NA NA 4.72 4.69 $169.11 $168.53 0%
99255 Inpatient consultation 4 4 NA NA 5.68 5.67 $203.50 $203.74 0%
2016 Medicare Physician Final Fee Schedule
Reimbursement & RVU Changes
CPT/
HCPCS Mod Description
2016
Work
RVUs
2015
Work
RVUs
2016 Total
Non-Facility
RVUs
2015 Total
Non-facility
RVUs
2016 Total
Facility
RVUs
2015 Total
Facility
RVUs
2016 Medicare
Payment (CF
35.8279)
2015 Medicare
Payment (CF
35.9335)
Percent
Difference
(Final 2016 vs.
Final 2015)
99288 Direct advanced life support 0 0 0 0 0 0.00 $0.00 $0.00 NA
99354 Prolonged service office 1.77 1.77 2.82 2.81 2.62 2.61 $93.87 $93.79 0%
99355 Prolonged service office 1.77 1.77 2.74 2.73 2.54 2.52 $91.00 $90.55 0%
99356 Prolonged service inpatient 1.71 1.71 NA NA 2.58 2.59 $92.44 $93.07 -1%
99357 Prolonged service inpatient 1.71 1.71 NA NA 2.57 2.56 $92.08 $91.99 0%
99401 Preventive counseling indiv 0.48 0.48 1.02 1.02 0.69 0.69 $24.72 $24.79 0%
99402 Preventive counseling indiv 0.98 0.98 1.74 1.74 1.42 1.41 $50.88 $50.67 0%
99403 Preventive counseling indiv 1.46 1.46 2.44 2.44 2.11 2.12 $75.60 $76.18 -1%
99404 Preventive counseling indiv 1.95 1.95 3.14 3.16 2.82 2.84 $101.03 $102.05 -1%
99411 Preventive counseling group 0.15 0.15 0.46 0.46 0.22 0.22 $7.88 $7.91 0%
99412 Preventive counseling group 0.25 0.25 0.6 0.61 0.36 0.37 $12.90 $13.30 -3%
99487 Cmplx chron care w/o pt vsit 0 0 0 0 0 0.00 $0.00 $0.00 NA
99489 Cmplx chron care addl 30 min 0 0 0 0 0 0.00$0.00 $0.00 NA
99490 Chron care mgmt srvc 20 min 0.61 0.61 1.14 1.2 0.88 0.92 $31.53 $33.06 -5%
99495 Trans care mgmt 14 day disch 2.11 2.11 4.6 4.63 3.11 3.13 $111.42 $112.47 -1%
99496 Trans care mgmt 7 day disch 3.05 3.05 6.49 6.5 4.5 4.51 $161.23 $162.06 -1%
99497 Advncd care plan 30 min 1.5 0 2.4 0 2.22 0.00 $79.54 $0.00 NA
99498 Advncd care plan addl 30 min 1.4 0 2.09 0 2.08 0.00 $74.52 $0.00 NA
G0104 Ca screen;flexi sigmoidscope 0.84 0.96 4.74 3.91 1.63 1.83 $58.40 $65.76 -11%
G0105 Colorectal scrn; hi risk ind 3.36 3.36 10.77 10.73 5.58 5.86 $199.92 $210.57 -5%
G0105 53 Colorectal scrn; hi risk ind 1.68 0.96 5.37 3.91 2.8 1.83 $100.32 $65.76 53%
G0106 Colon ca screen;barium enema 0.99 0.99 5.96 5.95 NA NANA NA NA
G0106 TC Colon ca screen;barium enema 0 0 4.55 4.53 NA NANA NA NA
2016 Medicare Physician Final Fee Schedule
Reimbursement & RVU Changes
CPT/
HCPCS Mod Description
2016
Work
RVUs
2015
Work
RVUs
2016 Total
Non-Facility
RVUs
2015 Total
Non-facility
RVUs
2016 Total
Facility
RVUs
2015 Total
Facility
RVUs
2016 Medicare
Payment (CF
35.8279)
2015 Medicare
Payment (CF
35.9335)
Percent
Difference
(Final 2016 vs.
Final 2015)
G0106 26 Colon ca screen;barium enema 0.99 0.99 5.96 1.42 NA 1.42NA $51.03 NA
G0120 Colon ca scrn; barium enema 0.99 0.99 6.01 5.95 NA NA NA NA NA
G0120 TC Colon ca scrn; barium enema 0 0 4.55 4.53 NA NA NA NA NA
G0120 26 Colon ca scrn; barium enema 0.99 0.99 6.01 1.42 NA 1.42 NA $51.03 NA
G0121 Colon ca scrn not hi rsk ind 3.36 3.36 10.78 10.73 5.59 5.86 $200.28 $210.57 -5%
G0121 53 Colon ca scrn not hi rsk ind 1.68 0.96 5.37 3.91 2.8 1.83 $100.32 $65.76 53%
G0122 Colon ca scrn; barium enema 0.99 0.99 7.56 7.5 NA NA NA NA NA
G0122 TC Colon ca scrn; barium enema 0.99 0 1.4 6.1 1.4 NA $50.16 NA NA
G0122 26 Colon ca scrn; barium enema 0.99 0.99 1.4 1.4 1.4 1.40 $50.16 $50.31 0%
G0328 Fecal blood scrn immunoassay 0 0 0 0 0 0.00$0.00 $0.00 NA
G0396 Alcohol/subs interv 15-30mn 0.65 0.65 1.01 1.02 0.95 0.96 $34.04 $34.50 -1%
G0397 Alcohol/subs interv >30 min 1.3 1.3 2.01 1.96 1.94 1.90 $69.51 $68.27 2%
G0402 Initial preventive exam 2.43 2.43 4.68 4.7 3.58 3.60 $128.26 $129.36 -1%
G0442 Annual alcohol screen 15 min 0.18 0.18 0.51 0.51 0.26 0.27$9.32 $9.70 -4%
G0443 Brief alcohol misuse counsel 0.45 0.45 0.73 0.73 0.67 0.67 $24.00 $24.08 0%
G0444 Depression screen annual 0.18 0.18 0.51 0.51 0.26 0.27 $9.32 $9.70 -4%
G0445 High inten beh couns std 30m 0.45 0.45 0.75 0.74 0.66 0.65$23.65 $23.36 1%
G0446 Intens behave ther cardio dx 0.45 0.45 0.73 0.73 0.67 0.67 $24.00 $24.08 0%
G0447 Behavior counsel obesity 15m 0.45 0.45 0.73 0.73 0.67 0.67$24.00 $24.08 0%
G0448 Place perm pacing cardiovert 0 0 0 0 0 0.00 $0.00 $0.00 NA
G0451 Devlopment test interpt&rep 0 0 0.25 0.27 NA NANA NA NA
2016 Medicare Physician Final Fee Schedule
Reimbursement & RVU Changes
CPT/
HCPCS Mod Description
2016
Work
RVUs
2015
Work
RVUs
2016 Total
Non-Facility
RVUs
2015 Total
Non-facility
RVUs
2016 Total
Facility
RVUs
2015 Total
Facility
RVUs
2016 Medicare
Payment (CF
35.8279)
2015 Medicare
Payment (CF
35.9335)
Percent
Difference
(Final 2016 vs.
Final 2015)
G0452 26 Molecular pathology interpr 0.37 0.37 0.52 0.53 0.52 0.53 $18.63 $19.04 -2%
G0453 Cont intraop neuro monitor 0.6 0.6 NA NA 0.93 0.93 $33.32 $33.42 0%
G0454 Md document visit by npp 0.18 0.18 0.26 0.26 0.26 0.26 $9.32 $9.34 0%
G0455 Fecal microbiota prep instil 1.34 1.34 3.64 3.69 2.1 2.14 $75.24 $76.90 -2%
G0458 Ldr prostate brachy comp rat 0 0 0 0 0 0.00 $0.00 $0.00 NA
G0459 Telehealth inpt pharm mgmt 0.95 0.95 NA NA 1.16 1.15 $41.56 $41.32 1%
G0460 Autologous prp for ulcers 0 0 0 0 0 0.00 $0.00 $0.00 NA
G0463 Hospital outpt clinic visit 0 0 0 0 0 0.00 $0.00 $0.00 NA
G0464 Colorec ca scr, sto bas dna 0 0 0 0 0 0.00 $0.00 $0.00 NA
