ASCO to Push Medicare on Fee Issue

The Health Care Financing Administration (HCFA) proposed increased reimbursement for two heavily used chemotherapy administration codes (90408 and 90410), but not nearly as much as ASCO had been pushing for. AMA’s relative value update committee (RUC) voted to accept ASCO’s data justifying an increase in the clinical staff time related to an oncologist’s expenses associated with both codes.This recommendation was forwarded to HCFA. Clinical staff time—the time a nurse or staff spends giving chemotherapy or educating a patient—is figured into the “practice expense,” which, with “physician work” (time spent face-to-face with the patient) and “malpractice expense,” is part of the formula for determining a CPT code’s relative value, which dictates reimbursement. However, HCFA slightly lowered the clinical staff times recommended by the RUC. Julie Taylor, deputy director of public policy for ASCO, says the group will be submitting comments to HCFA to accept the RUC recommendation. HCFA’s final decision will go into effect on January 1, 2001.