The 2013 Medicare Physician Fee Schedule (MPFS) final rule was published on Nov. 16. The fee schedule finalizes payment rates for all physician services, including payment rates for sleep testing. Payment for all services in the MPFS is calculated by multiplying the relative value units (RVUs) assigned to each component of the service by the designated conversion factor for the year. This article provides summary information about the payment rates for sleep testing effective Jan. 1, 2013.
Conversion Factor
The conversion factor is a dollar amount, established by the Centers for Medicare & Medicaid Services (CMS) each year. This dollar amount helps determine reimbursement for all services paid under the MPFS, including sleep services. For 2013, CMS has calculated a conversion factor of $25.0008, which is a cut of almost 27 percent of the current, 2012 conversion factor rate of $34.0376. The conversion factor calculation is based on the Sustainable Growth Rate (SGR) formula and this significant payment reduction will be implemented on Jan. 1, 2013 unless Congress takes action to delay the cut during the lame duck session.
Changes to Sleep Testing RVUs
According to the 2013 MPFS final rule, the RVUs assigned to physician work and professional liability insurance for sleep testing will not change in 2013. However, the RVUs for practice expense for sleep testing will change. In the case of out of center sleep testing codes (95800 and 95801) practice expense will increase in 2013. Practice expense for the in-center polysomnography codes (95808, 95810, and 95811) will decrease by 3-4 percent. This cut is less than the 7-9 percent cut to practice expense projected in the MPFS proposed rule, which the AASM reported in July. Sleep medicine has two new codes effective in 2013 – the pediatric sleep testing codes (95782 and 95783) have been assigned RVUs in the 2013 fee schedule.
National Payment
This chart reflects national payment if the conversion factor of $25.0008 is implemented
|
Code |
Descriptor |
2012 Total RVU |
2013 Total RVU |
RVU Difference |
National Payment |
|
95800 |
Sleep study, unattended w/ sleep time |
4.73 |
5.37 |
+ 12% |
$134.25 |
|
95801 |
Sleep study, unattended |
2.54 |
2.80 |
+ 9% |
$70.00 |
|
95803 |
Actigraphy testing |
4.86 |
4.48 |
– 8% |
$112.00 |
|
95805 |
MSLT/MWT |
12.27 |
12.62 |
+ 3% |
$315.51 |
|
95806 |
Sleep study, unattended w/ respir effort |
5.40 |
5.39 |
– |
$134.75 |
|
95807 |
Sleep study, attended |
14.64 |
14.69 |
– |
$367.26 |
|
95808 |
PSG, 1-3 additional parameters |
19.73 |
19.23 |
– 3% |
$480.77 |
|
95810 |
PSG, 6 yr or older, 4 or more additional parameters |
19.47 |
18.99 |
– 3% |
$474.77 |
|
95872 |
PSG, under 6 yr, 4 or more additional parameters |
NA |
31.35 |
NA |
$783.78 |
|
95811 |
PSG, 6 yr or older, 4 or more additional parameters w/ PAP |
20.76 |
19.92 |
– 4% |
$498.02 |
|
95873 |
PSG, under 6 yr, 4 or more additional parameters w/ PAP |
NA |
32.83 |
NA |
$820.78 |
The AASM will continue to provide members with up-to-date information about the 2013 conversion factor and payment for sleep services. Members with questions regarding 2013 payment can contact AASM staff at coding@aasm.org.
