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Use and cost of physician and supplier services under Medicare, 1986.

There is general consensus that the present Medicare physician payment system and related policies should be revised. Therefore, the Health Care Financing Administration and Congress are examining the physician reimbursement system for potential changes that could reverse the inflationary incentives in the present system and induce greater incentives for efficiency and cost savings. Medicare program data and information are provided to assist health care managers and administrators in the development and analysis of Medicare physician research and policy initiatives. The data may also be helpful in monitoring and measuring the use and cost of Medicare physician and supplier services as related to program performance and administration. Introduction Presented in this article are program data and information on the use and cost of physician and supplier services by Medicare beneficiaries during calendar year 1986. In addition, trend data (including actuarial projections) on national and Medicare physician expenditures (excluding supplier services, except for independent laboratories) are presented for selected calendar years, 1965-90. The use and cost of physician and supplier services are measured by the number of persons served, the number of services, submitted charges, allowed charges, and reimbursements. Beneficiary protection against out-of-pocket expenses (in excess of Medicare cost sharing) is measured by the Medicare assignment rate and reduction rate. Generally, a higher assignment rate and a lower reduction rate on unassigned claims will reduce the beneficiary out-of-pocket liability.

Physician services-those provided by doctors of medicine and osteopathy-represent services covered by Medicare Part B (supplementary medical insurance-SMI). Part B also pays for specified covered services provided by limited licensed practitioners LLP's)-e.g., doctors of dentistry or of dental oral surgery, chiropractors, doctors of podiatry or surgical chiropody, and doctors of optometry-and for covered services and supplies provided by suppliers-e.g., medical supply and ambulance companies, independent laboratories (billing independently), portable X-ray suppliers (billing independently), voluntary health and charitable organizations, and pharmacies. Physician and supplier services covered by the Medicare Part B program include diagnosis; therapy; surgery; consultation; home, office, and institutional visits; diagnostic X-ray tests; X-ray therapy; outpatient hospital diagnostic services; outpatient physical therapy and speech pathology; rental or purchase of durable medical equipment; surgical dressings, splints, casts, and other devices used for reduction of fractures and dislocations; ambulance services; institutional and home dialysis; prosthetic devices; and rural health clinic services.

Since its inception, the Medicare program has been paying physicians and suppliers, for the most part, on the basis of allowed charges for each unit of service rendered (i.e., fee for service). For covered physician services, Medicare pays 80 percent of the allowed charge after the beneficiary has met the annual deductible amount ($75 beginning in 1982). The allowed charge is the lowest of the physician's actual charge, customary charge, or prevailing charge. The customary charge is the amount the physician most frequently charged in the previous fee-screen year for a particular service furnished to all patients. The prevailing charge is the charge at the 75th percentile in an array of customary charges made for similar services by like physicians in the same locality during the previous year. Since 1975, the rate at which the prevailing charge can increase has been limited to the rate of increase in the Medicare Economic Index, which reflects the physician's cost of doing business.

Medicare allows physicians to determine how they will be paid for covered services rendered to Medicare beneficiaries. If the physician elects to be paid directly by the Part B carrier (the fiscal agent authorized by Medicare to determine amounts of payment due and to make such payments for covered services), the payments are deemed "assigned" and the physician agrees to accept, as payment in full, the amount the carrier determines as reasonable-i.e., the allowed charge. The program reimburses 80 percent of the allowed charge (after the beneficiary has met the annual deductible amount), and the beneficiary is responsible for the 20-percent coinsurance amount required by law. If the physician does not accept assignment, the patient is responsible for the entire submitted charge and must submit the bill to the carrier for reimbursement. In such cases, the beneficiary is responsible for paying the physician the difference (the reduction amount) between the physician's submitted charge and the Medicare allowed charge, as well as any deductible or coinsurance amounts. In 1986, the average reduction amount was about 28 percent.

From 1970 to 1986, the average annual rate of growth of Medicare reimbursements for physician services was 16.7 percent. The average annual rate of growth for all national health care expenditures during this period was 12.0 percent. To constrain the rate of growth in Medicare Part B physician expenditures, the Deficit Reduction Act (DEFRA) of 1984 placed a freeze on Medicare physician payment levels for a 15-month period beginning July 1, 1984. The freeze period payment levels were extended by Congress through April 1986 for participating physicians and through December 1986 for nonparticipating physicians.

In addition, DEFRA created the Medicare participating physicians and suppliers program (MPP)-that is, physicians who accept assignment for all Medicare services for that year and, thereby, agree to accept the allowed charge as payment in full. Medicare provided incentives to encourage physicians to participate in the MPP program. The effort resulted in a substantial increase in the rate of physician claims assigned, reaching approximately 70 percent in 1986; in 1983, the assignment rate was 52 percent.

There is general consensus that the present Medicare physician payment system and related policies should be revised. Therefore, the Health Care Financing Administration (HCFA) and Congress are examining the physician reimbursement system for potential changes that could reverse the inflationary incentives in the present system and induce greater incentives for efficiency and cost savings.

"Any proposal for reform of the Medicare physician payment policy should be evaluated in terms of several fundamental goals. They are: (1) to improve efficiency and establish fairer relative prices; (2) to provide incentives for appropriate utilization and cost-containment; (3) to help assure that high quality and effective medical care is delivered while discouraging ineffective treatments; and (4) to assure that beneficiaries have access to services. . . . In short, the above may be referred to as the issues of price, volume, intensity, effectiveness, and access" (Roper, 1988). Overview * In 1986, 30.6 million persons were enrolled in the Medicare supplementary medical insurance (SMI) program. Of these enrolled persons, 21.4 million beneficiaries (70 percent of all SMI enrollees) received reimbursable physician and supplier services during the year. * These beneficiaries received an estimated 734.2 million physician and supplier services under Medicare, an average of 34 services per user. * During 1986, physicians and suppliers submitted charges of $35.2 billion for services rendered to Medicare beneficiaries. Of this total, Medicare allowed charges of $25.4 billion and paid out $19.0 billion ($16.5 billion for physician services and $2.5 billion for supplier services); the difference ($6.4 billion) reflects beneficiary cost-sharing liability (deductible and coinsurance amounts). *The average allowed charge for Medicare physician and supplier services was $1,185 per user; the average reimbursement was $888 per user. *In 1986, an estimated 69 percent ($24.3 billion) of all submitted charges ($35.2 billion) for physician and supplier services were from claims taken on assignment. * The amount of reduction-the difference between submitted charges ($35.2 billion) and allowed charges ($25.4 billion)-amounted to $9.9 billion in 1986, or 28 percent of the total submitted charges. (Based on unpublished program data, an estimated $2.7 billion, or 27 percent of the total reduction amount, represents beneficiary out-of-pocket liability-that is, reduction liability on unassigned claims.) Data highlights Physician expenditures

Trend data on physician expenditures for 1970-86 (Table 1 and Figure 1) show the following: 9Total national health care expenditures for physician services were $92.0 billion in 1986; in 1970, the figure was $14.3 billion (Figure 1). From 1970 through 1986, the average annual rate of growth (AARG) in physician expenditures was 12.3 percent. (The national and Medicare physician expenditures shown in Table 1, as estimated by the Office of the Actuary, exclude supplier services, except for independent laboratory services.) Medicare reimbursements for physician services amounted to an estimated $19.0 billion in 1986, or about one-fifth of all physician expenditures in the United States ($92.0 billion). During the period 1970-86, Medicare physician expenditures increased at an AARG of 16.7 percent. (The Medicare physician expenditures ($19.0 billion) shown in Table I exclude supplier services of about $2.0 billion and are nearly the same as the Medicare physician and supplier expenditures shown in Tables 2-6. This is because of several factors described in the section on sources and limitations of the data: different sources and methods for estimating the data, different updates or completeness of the data, different methodology in measuring the cost of services, sampling variability, etc.) 9Expenditures for physician services under Medicare are projected (by the Office of the Actuary) to grow at an AARG of 13.5 percent, from $19.0 billion in 1986 to $31.5 billion in 1990. The lower projected growth rate reflects a number of factors, including a lower rate of inflation during the projection period, increased competition from outpatient departments, a continued decline in inpatient hospital use, and a larger role for hospital administrators in hospital management. 9 Medicare physician expenditures, as a proportion of

all Medicare expenditures, increased from 21.3

percent in 1970 to 24.5 percent in 1986. Type of service

Use and cost of physician and supplier services for 1986 are shown by type of service in Table 2, and the percent distribution of allowed charges is given in Figure 2. The program highlights that follow focus, for the most part, on allowed Medicare charges for physician and supplier services. * The difference between allowed Medicare physician and supplier charges ($25.4 billion) and reimbursements ($19.0 billion) represents beneficiary cost sharing (deductible and coinsurance amounts). * Medicare physician and supplier allowed charges are concentrated in two types of service. Medical care (primarily physician visits) and surgery accounted for 29.7 percent ($7.5 billion) and 30.9 percent ($7.8 billion), respectively, of all allowed charges for physician and supplier services (Figure 2). * Diagnostic radiology services accounted for 8.5 percent ($2.2 billion), and diagnostic laboratory services comprised 9.3 percent ($2.4 billion) of all * Medicare physician and supplier allowed charges. Together, these four types of services represented nearly four-fifths ($19.9 billion) of all allowed Medicare charges for physician and supplier services. * The average allowed charge per user of physician and supplier services ranged from $136 for diagnostic laboratory services to $894 for radiation therapy. * The number of services per user varied substantially among the different types of service, ranging from a low of 1.3 services for assistance at surgery to a high of 17.0 services for radiation therapy. * The assignment rate, based on submitted charges, ranged from a low of 58 percent for anesthesia services to a high of 76 percent for radiation therapy. * The reduction rate showed only small variation by type of service, with two exceptions; submitted charges for anesthesia and assistance at surgery were reduced by 43 percent and 38 percent, respectively. Place of service

The following data (allowed dollar amount, Table 3, and percent distribution of allowed charges, Figure 3) on the use and cost of physician and supplier services by place of service in 1986 show that: * Of all allowed Medicare physician and supplier charges ($25.4 billion), more than two-fifths (42 percent or $10.7 billion) were attributable to services provided on an inpatient hospital basis. * Another 29 percent ($7.4 billion) reflected services provided in a physician's office; care rendered in hospital outpatient facilities (including ambulatory surgical center care) accounted for 14 percent ($3.6 billion). Together, services provided in these three settings accounted for 85 percent of all Medicare- allowed physician and supplier charges. * Assignment rates were highest for services provided in the home (92 percent), in independent kidney disease treatment centers (92 percent), in independent laboratories (85 percent), and in skilled nursing facilities (82 percent). However, services provided in these settings, together, accounted for only 8 percent of all physician and supplier submitted charges. * Assignment rates for physician and supplier services in office and inpatient hospital settings were 56 percent and 70 percent, respectively; services provided in these settings accounted for 72 percent of all submitted charges ($35.2 billion). * Nearly all (19.8 million or 93 percent) persons receiving physician and supplier services (21.4 million) had an office visit, and more than one-half (11.2 million or 52 percent) used hospital outpatient services. (For the purpose of this article, hospital outpatient services include services rendered to beneficiaries in ambulatory surgical centers.) * Services provided in office (314.2 million or 43 percent) and inpatient hospital settings (174.5 million or 24 percent) accounted for more than two-thirds of all physician and supplier services (734.2 million) rendered during 1986; the average number of services per user was 15.9 and 22.2, respectively. * Among the places of service, the highest average allowed charge per person was shown for physician and supplier services in the inpatient hospital ($1,361). This was nearly 1 1/2 times higher than the place of service (independent kidney disease treatment center) with the next highest average charge ($927). Physician specialty Data on the use and cost of physician and supplier services by physician specialty (Table 4) and on the number of physician services per user and average allowed charge per user (Figure 4) show the following: * In 1986, internists and radiologists served more Medicare beneficiaries than did any other type of physician specialty; 52 percent (I 1. I million) of all persons served received physician services from internists, and 51 percent (I 1.0 million) were served by radiologists. *Supplier services were rendered to about 55 percent (11.8 million) of all Medicare users of physician and supplier services (21.4 million). *Suppliers provided an average of 15.3 services per user during 1986. Internists and family practitioners provided 14.2 and 10.2 services per user, respectively (Figure 4.) * Based on the amount of allowed charges, the leading physician specialties were internal medicine ($3.6 billion or 14 percent of all allowed charges), ophthalmology ($2.6 billion or 10 percent), and radiology ($1.8 billion or 7 percent). Together they accounted for $8.0 billion or 31 percent of all allowed Medicare physician and supplier charges. *Supplier services accounted for $3.4 billion or 13 percent of all allowed physician and supplier charges. * The average allowed charge per user for all types of physician specialties (including suppliers) was $1,185 in 1986. The average charges per user, by physician specialty, were highest for persons who used services in orthopedic surgery ($482), general surgery ($479), and ophthalmology ($408). The lowest average charges per user were for pathology ($74); otology, laryngology, and rhinology ($138); podiatry ($141); and chiropractic services ($146). * The highest assignment rates (based on submitted physician charges) among the physician specialties (excluding suppliers) were for podiatry (74 percent), pathology (73 percent), ophthalmology (73 percent), cardiovascular disease (73 percent), radiology (72 percent), and clinic or group practice (71 percent). (A higher assignment rate would tend to reduce out-of-pocket liability because the beneficiary is responsible for the reduction amount on unassigned claims.) * The highest reduction rates among the physician specialties were in anesthesiology (43 percent) and pathology (37 percent). (A lower reduction rate would tend to reduce the out-of-pocket liability because a smaller amount of reduction would be subject to beneficiary liability on unassigned claims.) Area of residence

Table 5 contains the following information on use and cost of Medicare physician services by area of residence for 1986. * Among the four U.S. census regions, the average allowed charge per user was highest in the West ($1,387), followed by the Northeast ($1,228), the South ($1,141), and the North Central ($1,065). * By division, there was marked variation in the average charge per user. The highest average charge in the Pacific Division ($1,463) was 52 percent higher than the average charge in the West North Central Division ($965). * The average number of services per user was highest in the North Central Region (38), followed by the Northeast (34), the South (33), and the West (32). * By division, the range was from a low of 30 services per person in the Mountain Division to a high of 41 per person in the East North Central Division, a difference of 37 percent. * Among the regions, assignment rates on submitted charges ranged from a low of 63 percent in the North Central to a high of 79 percent in the Northeast. * There was substantial variation in assignment rates among the divisions, ranging from 57 percent in the Mountain Division to 84 percent in New England. *The reduction rate among the regions was highest in the Northeast (31 percent) and lowest in the West (26 percent). * By division, there was only slight variation in the reduction rate, ranging from 26 percent in the Pacific Division to 31 percent in the Middle Atlantic. HCFA Common Procedure Coding System

Data in Table 6 are on the 1986 use and cost of physician services by the 23 leading services with their HCPCS (HCFA Common Procedure Coding System) codes. *Based on allowed charges, the leading Medicare physician services and related HCPCS codes (Technical note) during 1986 were extracapsular cataract removal (HCPCS-66984) ($1.25 billion); office medical services, intermediate service (HCPCS-90060) ($883 million); office medical services, limited services HCPCS-90050) ($785 million); hospital medical services, intermediate services (HCPCS-90260) ($716 million); and hospital medical services, limited services HCPCS-90250) 90250) ($540 million). Together, these 5 leading services accounted for $4.2 billion in allowed charges, or approximately 16 percent of all allowed physician and supplier charges. * The 23 selected leading services shown in Table 6 accounted for $8.4 billion of allowed physician and supplier charges, or one-third of all allowed Medicare physician and supplier charges during 1986. Similarly, in terms of number of services, the 23 leading services accounted for 243.0 million services, or one-third of all Medicare physician services (734.2 million). * For the leading services shown in Table 6, there wa substantial variation in the average allowed charge per user. The highest average allowed charges per user occurred for coronary artery procedures, coronary artery bypass (HCPCS-33512) ($3,920 per user); arthroplasty, total hip replacement HCPCS- 27130) ($2,199);extracapsular cataract removal (HCPCS-66984) ($1,895); and additional oxygenrelated supplies and equipment, oxyg en concentrator HCPCS-EI396) $1,703). * In contrast, 10 of the 23 leading services had an average allowed charge per user of less than $100; had an average charge ranging from 104-$162. * The number of services per user for the 23 leading services ranged from 1.2 for office medical services new patient, comprehensive service HCPCS-90020) and office medical services, established patient, comprehensive service (HCPCS-90080) to 9.6 for hospital medical services, intermediate service (HCPCS-90260) and hospital medical services, limited services (HCPCS-90250). Definition of terms

Assignment-Under supplementary medical insurance (Part B), if the beneficiary and the provider (physician or supplier) agree, the beneficiary may assign his or her rights to benefits to the provider. When this assignment method is used, the provider agrees that the total charge for a covered service will be the reasonable charge approved by the carrier. The provider submits a claim to the carrier and is reimbursed for the reasonable charge, less the 20 percent coinsurance and any deductible that remains unmet. The provider may then charge the beneficiary only for the coinsurance and any applicable deductible.

Carrier-A private or public organization with which HCFA enters into agreement to help administer the Part B benefits under Medicare. Also referred to as contractors," the carriers determine coverage and benefit amounts payable and make payment to physicians or suppliers or to beneficiaries.

Coinsurance-Under Part B, after the annual deductible has been met, Medicare will pay 80 percent of reasonable charges for covered services and supplies; the remaining 20 percent of reasonable charges is the cost sharing or coinsurance amount payable by the beneficiary.

Customary charge-The amount the physician usually bills patients for a particular service; that is, generally the charge most frequently made (50th percentile) by a physician for a particular service furnished to all patients in the previous calendar year.

Deductible-The amount payable by the beneficiary for covered services before Medicare makes reimbursement. The Part B deductible is the amount of reasonable charges (for covered services each calendar year) for which a beneficiary is responsible. This amount, currently fixed by law, is the first $75 of covered charges per calendar year, effective January 1, 1982.

HCFA Common Procedure Coding System (HCPCS)-HCPCS is based on the American Medical Association's (AMA) Physicians' Current Procedural Terminology, Fourth Edition (CPT-4). HCPCS includes three levels of codes and modifiers. Level one contains only the AMA CPT-4 codes (all numeric codes), with the exception of anesthesiology services. The second level contains the codes for physician and nonphysician services that are not included in CPT-4-e.g., ambulance, durable medical equipment, orthotics and prosthetics. These are alphanumeric codes maintained jointly by HCFA, Blue Cross and Blue Shield Association, and the Health Insurance Association of America. The third level (local assignment) contains the codes for services needed by individual contractors or State agencies to process Medicare and Medicaid claims. There is an upward progression of codes from the lowest (third) level to the highest (first) level (national assignment). HCFA monitors the system to ensure uniformity in level one and two codes.

Physicians' services-Under Medicare and Medicaid, physicians' services are those provided by an individual licensed under State law to practice medicine, osteopathy, dentistry, optometry, podiatry, or chiropractic therapy.

Prevailing charge-The prevailing charge is the charge at the 75th percentile in an array of the weighted customary charges made for similar services in the same locality. The prevailing charge, adjusted by the Medicare Economic Index, is the upper limit of charges deemed reasonable for Medicare reimbursement.

Reasonable charge-An individual charge determination made by a carrier on a covered Part B medical service or supply. In the absence of unusual medical complications or circumstances, the reasonable charge is the lowest of (1) the physician's or supplier's actual charge, (2) the physician's or supplier's customary charge for that service, or (3) the prevailing charge for the physicians or suppliers rendering the service in the same locality.

Reduction amount-The difference between the physician's submitted charge and the Medicare allowed charge.

Reduction rate-The ratio of the reduction amount to the physician's submitted charge.

Reimbursement amount-The amount reported as being paid by the Medicare program to or on behalf of the beneficiary for services provided by the physician or supplier, including institutions. For institutional providers, this is usually an interim amount that is adjusted at the end of the provider's fiscal year based on its cost report.

Supplementary medical insurance SMI)-SMI (also known as Part B) is a voluntary insurance program that provides insurance benefits for physician and other medical services in accordance with provisions of Title XVIII of the Social Security Act.

Supplier services-The supplementary medical insurance program pays for covered supplier services. As defined in the HCFA Part B Medicare annual data users' manual, these services include those provided by medical supply companies (durable medical equipment), ambulance suppliers, independent laboratories (billing independently), pharmacies, portable X-ray suppliers (billing independently), and voluntary health or charitable agencies. Sources and limitations of data

Trend data (1965-90) on national and Medicare physician expenditures shown in Table I represent the most current estimates developed by the Office of the Actuary. These physician expenditures exclude supplier services (except for independent laboratories), represent physician services compiled on a cash-flow basis, and represent a complete count of all physician expenditures.

The physician and supplier data shown in the balance of the article (Tables 2-6) were derived from the 1986 Part B Medicare annual data (BMAD) beneficiary file. The BMAD beneficiary file contains line-by-line detail from claims history of services received and expenditures incurred in calendar year 1986 for a 5-percent sample of aged and disabled beneficiaries.

The BMAD beneficiary file was implemented in 1984, and it provides detailed data on type of service, place of service, physician specialty, area of residence of beneficiary, and procedure codes from the HCFA Common Procedure Coding System (HCPCS). The file also contains the physician's submitted charges, the allowed charges under Medicare, and the amount reimbursed by Medicare. Data on the amounts reimbursed, however, are not available for HCPCS codes and the BMAD beneficiary file used to prepare this article.

The data were generated from BMAD statistical records for a 5-percent sample of Medicare beneficiaries. Therefore, the data are subject to sampling variability. Sample counts were multiplied by a factor of 20 to estimate population totals.

These BMAD data represent 1986 records received and processed in carriers as of March 1987. Records for 1986 recorded after that date were not included in the file used to prepare this article. Therefore, a complete count of all claims for physicians and supplier services during 1986 will probably increase the number of services and the amount of charges by about 5 percent above the figures shown in this article. Reference Roper, W. L.: Statement of Administrator, Health Care Financing Administration, before the Subcommittee on Health, Committee on Ways and Means, House of Representatives, Washington, D.C., May 24, 1988. Acknowledgments The authors greatly appreciate the substantial contributions of technical guidance and expertise provided by their colleagues Edye Fisher of the Office of Statistics and Data Management and William Sobaski and Sherry Terrell of the Office of Research. The authors also wish to thank the reviewers Charles Fisher, Terry Kay, Paul Gurny, Marian Gornick, and Herb Silverman. Statistical services, graphics, and secretarial services were provided by Brenda Boos, Thaddeus Holmes, and Beverly Ramsey, respectively, of the Office of Research. Finally, a special thanks to Will Kirby of the Office of Research and Mike Herman of the Office of Statistics and Data Management for their invaluable contributions in generating the data file and tables used to prepare this article. Technical note HCFA Common Procedure Coding System (HCPCS) codes for the 23 leading physician services, based on number of services: 1986 HCPCS
code Name of service
AOOIO Transportation services including
 ambulance, ambulance service, basic life
 support base rate, emergency transport,
 one way
E1396 Durable medical equipment, additional
 oxygen-related supplies and equipment,
 oxygen concentrator, equivalent to over
 1,952 cubic feet
27130 Pelvis and hip joint, repair, revision or
 reconstruction arthroplasty, acetabular and
 proximal femoral prosthetic replacement
 (total hip replacement)
33512 Heart and pericardium, coronary artery
 procedures, coronary artery bypass,
 autogenous graft (EG, saphenous vein or
 internal mammary artery); three coronary
 grafts
52601 Urodynamics, transurethral surgery (vesical
 neck and prostate), including control of
 postoperative bleeding, complete
 (vasectomy, meatotomy,
 cystourethroscopy, urethral calibration
 and/or dilation, and internal urethrotomy
 are included)
66983 Anterior segment, removal cataract,
 intracapsular cataract extraction with
 insertion of intraocular lens prosthesis
 (one-stage procedure)
66984 Anterior segment, removal cataract,
 extracapsular cataract removal with
 insertion of intraocular lens prosthesis
 (one-stage procedure), manual or
 phacoemulsification technique


HCPCS
code Name of service
71010 Diagnostic radiology, chest, radiologic
 examination, chest; single view, frontal
71020 Diagnostic radiology, chest, radiologic
 examination, chest; two views, frontal and
 lateral
90020 Office medical services, new patient,
 comprehensive service
90040 Office medical services, established patient,
 brief service
90050 Office medical services, established patient,
 limited service
90060 Office medical services, established patient,
 intermediate service
90070 Office medical services, established patient,
 extended service
90080 Office medical services, established patient,
 comprehensive service
90220 Hospital medical services, new and
 established patient, initial hospital care,
 comprehensive history and examination,
 initiation of diagnostic and treatment
 programs, and preparation of hospital
 records
90240 Hospital medical services, new and
 established patient, subsequent hospital
 care, each day, hospital subsequent care
 requiring; brief service
90250 Hospital medical services, new and
 established patient, subsequent hospital
 care, each day, hospital subsequent care
 requiring; limited services
90260 Hospital medical services, new and
 established patient, subsequent hospital
 care, each day, hospital subsequent care
 requiring; intermediate services
90270 Hospital medical services, new and
 established patient, subsequent hospital
 care, each day, hospital subsequent care
 requiring; extended services
90620 Consultations, initial consultation,
 comprehensive
93000 Cardiovascular, cardiography,
 electrocardiogram, routine ECG with at
 least 12 leads; with interpretation and
 report
93010 Cardiovascular, cardiography,
 electrocardiogram, routine ECG with at
 least 12 leads; with interpretation and
 report only
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Author:Helbing, Charles; Keene, Roger
Publication:Health Care Financing Review
Date:Mar 22, 1989
Words:4726
Previous Article:Developing payment refinements and reforms under Medicare for excluded hospitals.
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