The Center for Medicare and Medicaid Services (CMS) has revised the 2011 Physician Fee Schedule, decreasing the final 2011 Medicare Physician conversion factor from the 2010 rate of $36.8729 to $33.9764. The revisions also include updates to sleep medicine codes, including 95800 and 95801.

According to an AMA Wire article, “The most significant reason for the change [to the conversion factor] is that the final rule included a reweighting of the work, practice expense and liability expense components of the relative value scale that reduced the numerical value of the conversion factor, even though the net impact of these changes is budget neutral.”

According to a Special Update from the American Academy of Sleep Medicine (AASM), payment (work + practice expense + professional liability insurance) for 95800 is $205.56. Using the same calculation, 95801 is set at $96.83.

Sleep Review is conducting a Sleep Center Survey to get a greater understanding of the impact of reimbursement changes. Take this survey and we will send you a free copy of the report we produce.

“The AASM is taking a strategic approach to sleep medicine CPT codes, and the examination of new codes is a major area of address for the Future of Sleep Medicine Task Force,” the AASM Special Update stated. “The Future of Sleep Medicine Tools Workgroup is evaluating current and new technologies to determine the feasibility of new codes for sleep medicine, and recommendations will be made at the next meeting in February.”

“All 2011 claims are expected to be paid on time and at the correct rates with no adjustments or claims holds necessary,” the report from AMA Wire stated.

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