GOVERNMENTDoctors knock Medicare vaccination payments as too lowCMS' refusal to increase immunization pay rates may hurt chances of reaching Healthy People 2010 goals.By Markian Hawryluk, amednews staff. Aug. 5, 2002. Washington -- Physicians hoping for a shot in the arm from the Centers for Medicare & Medicaid Services in the push to boost immunization rates among the elderly have come away smarting. In its recent proposed rule on the Medicare physician fee schedule for 2003, CMS increased payment rates for most immunizations but not for influenza, pneumococcal and hepatitis B vaccine administration. Physician practices may not be able to continue to absorb those losses along with increases in costs. "When you consider the fact that physicians are facing financial pressure from so many sources, such as the reduction in Medicare payment for physician services and increasing medical liability insurance premiums, it's very difficult to handle inadequate reimbursement for individual services such as this one," said Ronald M. Davis, MD, a preventive medicine physician from East Lansing, Mich., and an AMA trustee. While private plans rely on current procedural terminology codes for immunization claims, CMS requires doctors to use special "G codes" when billing for flu, pneumonia or hepatitis B vaccination. But the G codes are linked to CPT codes for therapeutic injections, which will pay only $3.80 in 2003. Other vaccinations are paid according to the CPT code for vaccine administration, or $7.61 in 2003. Physicians have complained that the G codes represent an additional hassle required only by Medicare. CMS has indicated it needs the G codes because immunization claims cannot be counted in sustainable growth rate expenditures when calculating the physician payment update. If the G codes cannot be eliminated, physician groups say, CMS should at least reimburse practices at the vaccine administration rate.
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Copyright 2002 American Medical Association. All rights reserved.
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