CMS released the Medicare Physician Fee Schedule (MPFS) CY 2011 final rule on November 2, 2010.  As we are all aware, the conversion factor used to calculate reimbursement under the MPFS has been in limbo  for much of CY 2010 and unfortunately, the uncertainty has not ended.  In CY 2010 CMS finalized their intention to reduce the  conversion factor by 21.3%, this reduction was delayed multiple times in 2010 and physicians were actually given a 2.2% update beginning June 1, and ending November 30, 2010.  In the final rules, CMS announced that effective December 1, 2010 the new conversion factor would be $28.3868 and that beginning January 1, 2011 it would decrease even further to $25.5217.  The will mean a greater than 30% cut to physician payment in less than a 2 month period unless Congress addresses the issue soon.

If the conversion factor does not decrease most Radiation Oncology codes will see modest increases in reimbursement due to increased RVUs.  Physicians will also have some new CPT codes available to report fiducial markers implants or vaginal brachytherapy treatment devices.

49327 Laparoscopy, abdomen, peritoneum, and omentum, diagnostic with or without collection of specimen(s) by brushing or washing (separate procedure) with placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers,  dosimeter), intra-abdominal, intrapelvic and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure.

49412 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), open, intra-abdominal, intrapelic and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure).

57156 Insertion of a vaginal radiation after-loading apparatus for clinical brachytherapy.

Also of note is the change in directive verbiage for CPT® code 77427 used to report the physician's weekly treatment management services.  Now included is the statement that the radiation treatment management requires and includes a minimum of one examination of the patient by the physician for medical evaluation and management (eg, assessment of the patient's response to treatment, coordination of care and treatment, review of imaging and/or lab test results with documentation) for each reporting of the radiation treatment management service.