White Papers

Prostate Biopsies Reduced Once Again in Medicare Proposed Fees for 2018

The Medicare Physician Fee Schedule (MPFS) proposal for 2018 includes a 19% cut to the technical component for prostate biopsies (G0416) while professional fees will remain unchanged. If finalized, global reimbursement will decline by 11.5% to $434. Global reimbursement for the 12-core prostate biopsy has been reduced 66% over the past six years. There is some positive news concerning a small increase for CPT 88305.

Overall, CMS estimates that the proposed changes for 2018 will decrease pathologists’ Medicare fees by 1% while independent technical lab rates will be reduced by 2%. CMS is accepting comments on the proposed MPFS through September 11, 2017. Final rates are expected to be announced in October and become effective January 1, 2018.

CPT 88305
The proposed Medicare Physician Fee Schedule for 2018 includes a 1.2% increase to the professional interpretation for CPT 88305, which, if finalized, would raise it to $40.31. The rate for the technical component is being increased by 0.3% to $29.87. Overall, the global rate for CPT 88305 will increase by a proposed 0.8% to $70.18.

Immunohistochemistry
The global rate for CPT 88342 (IHC first stain procedure) is proposed to remain at $108.33; pro interpretation down 0.7% to $37.07; technical component up 0.3% to $71.26.

The global rate for CPT 88341 (IHC, additional slide) is proposed to increase 1.1% to $93.21; professional interpretation up 0.3% to $29.87; technical component up 1.4% to $63.34.

Flow Cytometry
Following significant cuts made in 2017, more cuts for flow cytometry codes are proposed for 2018. CPT 88185 (flow cytometry, TC, add on) is proposed to drop by 18.8% to $30.59. CPT 88189 (flow cytometry, interpretation, 16 or more markers) is proposed to decrease by 4.4% to $88.54.

Please see the below PDF for all of the proposed changes.

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Follow Up to CMS' Local Coverage Determination (LCD) L35922 (IHC/Special Stains)
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