PEDIATRICIANS, PATIENTS BENEFIT FROM ADEQUATE PHYSICIAN PAYMENT
Inclusion of procedural codes will provide compensation for health services

Washington, DC - The American Academy of Pediatrics (AAP), representing 60,000 pediatricians, commends the Centers for Medicare and Medicaid Services (CMS) for including four CPT (Current Procedural Terminology) codes, often used by pediatricians, in the final version of the Medicare Physician Fee Schedule released Nov. 1. The inclusion of these codes, as well as the corresponding relative value units (RVUs) for each code, will have a significant impact on pediatricians and the services they provide to children.

"Although most pediatricians are not paid by Medicare, 75 percent of private payers use Medicare rates to set their physician payments," said AAP President Jay E. Berkelhamer, MD, FAAP. "By adding these codes to the final version of the fee schedule, pediatricians can be appropriately compensated for the care they provide."

The relative values for the four CPT codes, 92551, 99173, 99339 and 99340, were previously recommended to CMS for inclusion in the Physician Fee Schedule by the AAP and the American Medical Association (AMA)/Specialty Society Relative Value Scale Update Committee (RUC). The codes are for hearing (92551) and vision (99173) screenings and care plan oversight (99339-99340) often used by the practicing pediatrician. Adding the codes to the schedule will have little or no effect on Medicare costs because the Medicare program does not pay for them. Pediatricians should examine their private payer contracts to ensure that the new codes are recognized.

"Adequate payment for the services pediatricians provide has significant benefits for their practices and their patients," Dr. Berkelhamer said. "For example, pediatricians could start investing in electronic medical records for their practices, and they could expand access to health care for other children."

Pediatricians typically receive lower payment rates than other providers, particularly within the Medicaid program. Medicaid is the largest children's health program in the country. As a national average, Medicaid currently pays only 69% of what Medicare pays for the same service. Without proper payment and less administrative paperwork, fewer physicians may be able to participate in Medicaid, threatening children's access to quality health care.

# # #

The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well being of infants, children, adolescents and young adults.