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2021 Medicare Fee Schedule Quickie Analysis
Did a quick comparison of the 2021 Medicare fee schedule (Southern CA) for the money makers, and this is the percent decreases to TC – technical, 26 – professional and the (blank cell) is global. I threw in 2006 pre-DRA for fun.
Surprising professional reimbursement has actually held up pretty well since 2006… The implosion in technical fees was NOT fun….
[i]OK, came out all wonkie, but you get the point.[/i][b] [/b]
[b]MRI[/b] [b]2021[/b] [b]2020[/b] [b]diff[/b] [b]2006[/b] [b]diff[/b]
BRAIN W/O
70551 $237.79 $258.01 – 8% $568.65 – 58%
70551 TC $165.76 $176.65 – 6% $490.01 – 66%
70551 26 $72.03 $81.36 – 11% $95.22 – 24%
BRAIN W/WO CONTRAST
70553 $390.42 $423.10 – 8% $ 1,213.59 -68%
70553 TC $279.48 $297.61 – 6% $ 1,088.64 -74%
70553 26 $110.94 $125.48 – 12% $124.95 -11%
L SPINE W/O
72148 $232.84 $251.39 – 7% $622.65 -63%
72148 TC $160.43 $170.03 – 6% $544.01 -71%
72148 26 $72.41 $81.36 – 11% $78.65 -8%
L SPINE W/WO CONTRAST
72158 $393.60 $425.64 – 8% $ 1,213.59 -68%
72158 TC $282.28 $300.16 – 6% $ 1,088.64 -74%
72158 26 $111.32 $125.48 – 11% $ 124.95 -11%
UPPER JOINT W/O
73221 $247.08 $266.68 – 7% $ 554.42 -55%
73221 TC $180.61 $191.51 – 6% $ 483.11 -63%
73221 26 $66.47 $75.17 – 12% $ 71.31 -7%
UPPER JOINT W/WO CONTRAST
73223 $491.28 $528.05 – 7% $ 1,186.53 -59%
73223 TC $386.49 $410.51 – 6% $ 1,072.42 -64%
73223 26 $104.80 $117.55 – 11% $ 114.11 -8%
LOWER JOINT W/O
73721 $246.70 $265.74 – 7% $ 554.42 -56%
73721 TC $180.23 $191.51 – 6% $ 483.11 -63%
73721 26 $66.47 $74.23 – 10% $ 71.31 -7%
LOWER JOINT W/WO CONTRAST
73723 $489.38 $527.21 – 7% $ 1,186.53 -59%
73723 TC $384.96 $409.66 – 6% $ 1,072.42 -64%
73723 26 $104.42 $117.55 – 11% $ 114.11 -8%
[b]CT[/b]
HEAD W/O
70450 $124.15 $133.00 – 7 % $ 251.54 -51%
70450 TC $82.88 $86.42 – 4% $ 206.44 -60%
70450 26 $41.27 $46.58 – 11% $ 45.10 -8%
ABDOMEN W/WO CONTRAST
74176 $212.86 $229.22 – 7% BUNDLED
74176 TC $128.57 $133.95 – 4% BUNDLED
74176 26 $84.29 $95.26 -12% BUNDLED
[b]US[/b]
HEAD AND NECK
76536 $130.05 $135.53 – 4% $ 91.45 42%
76536 TC $102.68 $104.67 – 2% $ 62.15 65%
76536 26 $27.37 $30.86 – 11% $ 29.31 -7%
ABDOMEN COMPLETE
76700 $134.22 $142.52 – 6% $ 125.54 7%
76700 TC $94.68 $97.88 – 3% $ 86.60 9%
76700 26 $39.54 $44.65 – 11% $ 38.94 2%
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13 Replies
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Formatting is definitely bonkers. Our billers estimated 2.5% decrease in GCR based on our payor mix.
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your billing company or person or rep have no idea what they are doing.
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Our billing company is amazing. But thanks for the concern.
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Well, good for you guys.
I think its far far worse than this for most practices. 11 percent might be conservative. Would depend on payer mix and also what private insurance does-
So there’s no movement in Congress on the “bipartisan” bill that would increase spending to make up for these cuts.
Something is telling me Pelosi got upset that her surprising bills benchmarking solution failed, and now she’s not at all against dragging Congress down the rabbit hole with her states bailout poison pills, even if it means these cuts will happen despite the “bipartisan” effort to stop them.
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Something tells me you should go speculate on some other message board
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Thanks for generating this. Informative. I wonder how hospitals stayed profitable during these large cuts.
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Quote from drad123
Thanks for generating this. Informative. I wonder how hospitals stayed profitable during these large cuts.
Pretty easy actually. It only works when you start out big. You don’t have competition so you can charge more to non-Medicare patients and insurance companies. You can snatch up money losing hospitals in smaller areas to expand your reach and bargaining power. As you get larger and buy up the smaller groups, you can then cut salaries as you see fit while maintaining and increasing volumes. Where are those employees going to go? Sell their homes, uproot their families, and move to a place without a social network? It’s easy. No MBA necessary to see how it can be done and make money hand over fist.-
You can see all exams types now at the acr website
[link=https://www.acr.org/Advocacy-and-Economics/Advocacy-News/Advocacy-News-Issues/In-the-Dec-19-2020-Issue]https://www.acr.org/Advoc…-the-Dec-19-2020-Issue[/link]-
So what could be the net impact from both the MPFS final rule changes and the passage of the surprise billing legislation? Looks like Congress is also going to pass surprise biliing legislation as part of the year end spending package today.
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Quote from Raddoc
So what could be the net impact from both the MPFS final rule changes and the passage of the surprise billing legislation? Looks like Congress is also going to pass surprise biliing legislation as part of the year end spending package today.
E/M cuts were down to -4% from -10%.
Not sure if one can predict how SMB will affect things but apparently what was included in this bill was better than alternatives
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What about inflation adjustments?
$77 in 2006 is about $100 today
$100 in 2006 is about $131 today.-
Great point.
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