Over the years, we have written and spoken about the CPT®code development process and the process the AMA/Specialty Society RVS Update Committee (the RUC) follows to establish the values it recommends to the Centers for Medicare & Medicaid Services (CMS) to assign to the services described by these codes. However, the fact that a service has a CPT code and that the code has been assigned a value does not necessarily mean that Medicare provides coverage for that service. In this month’s column, we look at the Medicare local coverage determination process – with some focus on recent and important changes that CMS has made in this area.
The Medicare Physician Fee Schedule (MPFS) includes not only payment amounts, but also provides a great deal of policy information. One important example of the latter is the Status Indicator. Table 1, next page, provides some examples relevant to...
