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CPT Changes for 2018: What ENTs Need to Know

CPT Changes for 2018: What ENTs Need to Know

There are several Current Procedural Terminology® (CPT) code changes for 2018 applicable to Otolaryngologist–Head and Neck Surgeons. Below is a summary of these changes. If you have any questions regarding CPT code changes for 2018, please contact the Health Policy team

What ENTs Need to Know

As the medical community has come to expect, part of the annual rulemaking process conducted by the Centers for Medicare & Medicaid Services (CMS) includes the issuance of new and modified CPT codes, developed by the American Medical Association's (AMA) CPT Editorial Panel, for the coming year. In addition, CMS includes new, or updated, values (also known as relative value units (RVUs)) for medical services which have undergone review by the AMA RVS Update Committee (RUC). CMS has the discretion to accept the RUC's RVU recommendations for physician work, as well as recommendations for direct practice expense inputs, or it may exercise its administrative authority and elect to assign a different value, or practice expense inputs, for medical procedures paid for by Medicare. The final value, as determined by CMS, is then publicly released in the final Medicare Physician Fee Schedule (MPFS) rule for the following calendar year.

The AAO-HNS is an active participant in both the AMA RUC valuation of otolaryngology-head and neck services, and the CMS annual rulemaking process. As part of those efforts, we want to ensure members are informed and prepared for key changes to CPT codes and valuations related to otolaryngology-head and neck surgery services for CY 2018. Below is a list of codes changed in 2018, including new and revised CPT codes that went through the CPT and RUC processes.

New and Modified Codes

In CY 2018, several new CPT codes were developed for otolaryngology services. Changes were made to the following CPT codes which were subsequently valued by the AMA RUC:

  • 15732-15738 Muscle Flap Family (previously 3 codes, now 5)
  • 30140 Submucous resection inferior turbinate, partial or complete, any method
  • 30901-30906 Control of Nasal Hemorrhage Family
  • 31295-31297 Balloon Sinuplasty Family (previously 3 codes, now 4)
  • 31256-31288 Functional Endoscopic Sinus Surgery Family (previously 7 codes, now 11)
  • 31600-31610 Tracheostomy Family
  • 95004 Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction

(An updated AMA CPT Assistant article is being drafted to provide clarification on the use of new bundled codes for the FESS and balloon sinuplasty codes.)

Additional Codes to be Addressed in the CY 2019 MPFS

A number of existing CPT codes relating to otolaryngology were reviewed by the AMA RUC, and their RUC-approved values were submitted to CMS for final determination for the CY 2019 MPFS final rule. Members should be prepared for modified RVUs for some, or all, of these procedures in CY 2019. CMS will publish proposed values within the MPFS proposed rule, typically published the first week of July. The AAO-HNS will monitor the recommended values for these services and comment on our members’ behalf. Final values will be released within the final MPFS which is issued by CMS typically around November 1 of each year. Upon receipt, the AAO-HNS will summarize the final rule and alert members to critical changes in reimbursement for any of the following medical procedures. Services which were reviewed include:

  • 10021 Fine needle aspiration;without imaging guidance
  • 10022 Fine needle aspiration; with imaging guidance