Physicians will see a small $0.08 increase to the Medicare payment per RVU in 2017.

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ACEP Now: Vol 36 – No 01 – January 2017

The biggest change is that the intraservice time thresholds have dropped from 30 minutes to 15 minutes. Current Procedural Terminology (CPT) instructs that for any time-based code, a unit of time is attained when the midpoint is passed unless there are code- or code range–specific instructions in the guidelines, parenthetical instructions, or code descriptors to the contrary. In 2017, there is a chart, similar to the one in the critical care code section, which lists the correct moderate sedation code to assign based on the provider situation and the total intraservice time. The CPT moderate sedation table shows that sedation services would now be reportable once the physician exceeds 10 minutes of intraservice time.

Intraservice time begins with the administration of the sedating agent; requires continuous face-to-face attention of the provider and monitoring of the patient’s response to the sedation, periodic reassessments, and vital signs including oxygenation, heart rate, and blood pressure; and ends when the procedure is completed, the patient is stable, and the provider providing sedation ends personal face-to-face care of the patient.

New Modifier 95 for Synchronous Telemedicine Services

As telemedicine technology continues to improve, there has been an increasing demand for an accepted mechanism to identify and report services provided by a remote physician. The CPT editorial panel considered this issue for many years before a joint CPT and Relative Value Scale Update Committee Telehealth Services workgroup was convened to make a recommendation on how best to move forward. In 2017, CPT added modifier 95 (synchronous telemedicine services rendered via real-time interactive audio and video telecommunications system) for use in identifying services provided via telemedicine.

The modifier descriptor specifies that the service must be synchronous, meaning in real time, for correct application. The qualified provider must be using real-time audio and video telecommunications between the patient and the distant site in which the provider practices, and the totality of the information exchanged must be commensurate with the key components or other requirements to have reported the service or procedure as if the distant provider were physically present with the patient.

Additionally, the 2017 CPT book added new Appendix P, which lists codes that may be used for reporting synchronous telemedicine services when using interactive telecommunications equipment that includes, at a minimum, audio and video. The codes listed in Appendix P will now be marked with a star symbol (☆) where they appear normally in the book.