Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

2017 Medicare Physician Fee Schedule: Anesthesia Conversion Factor and Other Related Issues


When the Centers for Medicare and Medicaid Services (CMS) released the 2017 Medicare Physician Fee Schedule (MPFS) earlier this month, that final rule also included the 2017 Anesthesia Conversion Factor of $22.0454, which represents an approximate .25 percent increase.

For anesthesiologists billing in Indiana, the Medicare Administrative Contractor WPS Government Health Administrators has posted geographically adjusted anesthesia conversion factors on their website, including the factor for participating physicians and CRNAs of $21.09.

Updates to the anesthesia conversion factor follow the same methodology as the general conversion factor, which is set at $35.89 for 2017. While increases to the 2017 fee schedule were legislated at .5 percent under MACRA, in another law, the Achieving a Better Life Experience (ABLE) Act of 2014, Congress mandated adjustments to misvalued codes (1 percent in 2016 and .5 percent in 2017 and 2018) in the fee schedule. If the mandated adjustments fell short of the targets, then the difference would be pulled from the .5 percent MACRA increase.

Since savings through misvalued codes was estimated at only .32 percent, that adjustment, plus other mandated adjustments, were made to the conversion factor, resulting in an approximate .25 percent increase over the 2016 MPFS conversion factor of $35.80.

There were a couple other items in the 2017 MPFS related to anesthesiologists.

Potentially Misvalued Codes

CMS has flagged ASA codes 00740 and 00810, used to report anesthesia furnished in conjunction with lower gastrointestinal procedures, as potentially misvalued. At present, no changes are being recommended to the 5 base units for these codes; however, CMS indicated in the final rule that they are still considering a change based on continued stakeholder feedback.

Moderate Sedation

Also, CMS finalized its proposed modifications to revalue several procedure codes to remove the work RVUs associated with moderate sedation. The work RVUs for GI endoscopy procedures will be reduced by .10, and all other services by .25 from current values.

Gastroenterology procedures were treated differently than other surgical procedures, according to CMS, because “gastroenterologists furnish the highest volume of services previously identified in Appendix G, and services primarily furnished by gastroenterologists prompted the concerns that led to our identification of changes in medical practice and potentially duplicative payment for these codes.”

Anesthesiologists furnishing the moderate sedation services will have no change in their overall work RVUs, but they should be aware of the changes to billing guidelines for the surgical portion of the procedure.

For more information about the 2017 MPFS, read our recent overview blog post, review the CMS Fact Sheet, “Final Policy, Payment, and Quality Provisions in the Medicare Physician Fee Schedule for Calendar Year (CY) 2017,” or scan through the 393-page final rule located on the federalregister.gov.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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