Immunohistochemistry and enhanced cytology services took a big hit in the final Physician Fee Schedule rule for 2014, with the Centers for Medicare and Medicaid Services (CMS) cutting payment for both as part of its code revaluation initiative. Under the final rule, released Nov. 27, two new G codes have been established to replace CPT 88342 (immunohistochemistry). Global payment for G0461 will be reduced by 24 percent when compared to current levels for 88342 while global payment for G0462 will be cut by 41 percent compared to current levels. Enhanced cytology services (CPT 88112) also will be cut significantly in 2014, with the technical component (TC) cut by 33 percent, the professional component (PC) cut by 52 percent, and global payment cut by 43 percent. CMS deferred action on revaluation of the PC and TC of in situ hybridization services (88365, 88367, and 88368) until 2015 and also decided to not to further reduce payment for the TC of 88305. Prostate Biopsies CMS also imposed new restrictions on billing of 10 or more prostate biopsy specimens and will require individuals who bill more than 10 to use a G code to bill. These changes are designed to clear up confusion over what code to use for multiple biopsies. Effective Jan. 1, 2012, a National Correct Coding Initiative edit limited the number of prostate biopsies that could be reported using 88305 to four, which resulted in a significant cut in payment for more than four biopsies. Under this new policy, up to nine prostate biopsies can be reported using 88305. For 10-20 prostate biopsies, providers will bill using G0416 (Surgical pathology, gross and microscopic examination for prostate needle biopsies, any method; 10-20 specimens). G0417 is used for 21-40 specimens. G0418 is used for 41-60 specimens, and G0419 is used for more than 60 specimens. Physician Quality Reporting System While CMS did not accept the College of American Pathologists’ (CAP’s) three new pathology measures in its final rule, CMS will allow pathologists to qualify for 2014 incentives by reporting on the existing five measures proposed by CAP by either claims or registry. Until now, the measures could be reported only by claims. CAP supports this change, noting that a greater number of pathologists are able to qualify for incentives when they report using a registry. In 2011, pathologists received on average a bonus of $856.50. By participating in the 2013 Physician Quality Reporting System (PQRS), pathologists avoided penalties that begin at 1.5 percent of their Medicare Part B billing in 2015 and rise to 2 percent in subsequent years. These measures take effect Jan. 1, 2014. “While CAP is disappointed that its three new pathology measures were not included in the 2014 PQRS measure set, the CAP is pleased that CMS accepted the CAP’s request that the registry reporting option be available to those with fewer than nine measures,” said Jonathan Myles, M.D., chair of CAP’s Economic Affairs Committee. “The CAP will continue to engage and educate policymakers about the difficulties pathologists have meeting current CMS requirements and will continue to seek relief from penalties in cases where pathologists have no pathway in which to meet requirements.”