AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES
Resolution: 110
(A-05)
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Introduced by:
New York Delegation
Subject:
Proper Classification of Diagnostic Tests on the Medicare Physician Fee
Schedule
Referred to:
Reference Committee A
(Alfred Herzog, MD, Chair)
Whereas, The Medicare Physician Fee Schedule Database (MPFSDB) that is maintained by the
Centers for Medicare and Medicaid Services (CMS) contains payment and policy indicators for
all of the procedures and services that are listed in the Medicare Physician Fee Schedule; and
Whereas, This database contains a “diagnostic test” category (Indicator 1), which includes such
diagnostic and radiological services as pulmonary function tests and therapeutic radiology
procedures; and
Whereas, The MPFSDB also contains a “physician services” or “medical services” category
(Indicator 0); and
Whereas, Per CMS policy regarding “global surgical period” and “medical care on the same day
as surgery,” it is permissible for the carrier to “bundle” Indicator 0 services (“physician services”)
into surgeries performed on the same day or within the post-operative period; and
Whereas, Many commercial carriers have adopted this CMS bundling policy with the aim of
containing costs; but certain Indicator 0 services have been miscategorized by CMS, in that they
are not actually visits, consultations, or surgical services, but instead are adjunct testing
services which are diagnostic in nature and are used in the overall treatment and management
of the patient (examples include indirect ophthalmoscopy, 92225, and ingestion challenge test,
95075); and
Whereas, It would be advisable to remove these adjunct services from the Indicator 0 category,
so that they can no longer be “bundled” with surgeries; therefore be it
RESOLVED, That our American Medical Association study a possible change in the Medicare
Physician Fee Schedule Database (MPFSDB), focusing on all “Indicator 0” codes that are
actually diagnostic tests and contemplating their reclassification as “Indicator 1” codes, so that
they can no longer be bundled with surgical procedures (as outlined in Medicare’s policies
regarding “global surgical period ” and “medical care on the same day as surgery”), and that this
study be conducted on a specialty-specific level (Directive to Take Action); and be it further
RESOLVED, That our AMA request that Centers for Medicare and Medicaid Services make
these changes in the MPFSDB, if the results of the study so warrant. (Directive to Take Action)
Fiscal Note: Study possible change in the Medicare Physician Fee Schedule Database at an
estimated total cost of $6,060.
Received: 5/11/05
Resolution: 110 (A-05)
Page 2
RELEVANT AMA POLICY
D-330.973 Requirement for Physicians to Sign Written Requests for Diagnostic Tests
Our AMA will work with the Centers for Medicare and Medicaid Services to publish instructions
to Medicare contractors that clarify that the signature of the ordering physician is not required on
a clinical diagnostic test order, if the order is documented in the medical record. (Sub. Res. 114,
I-01)
H-320.976 Medical Necessity of Diagnostic Tests
Our AMA approves the principle that the indication for a diagnostic test is based on the
suspected diagnosis of a clinical disorder and that a test with normal results is not de facto
unnecessary. (Res. 97, A-90; Reaffirmed: Sunset Report, I-00)
H-390.923 Purchased Diagnostic Tests
It is the policy of the AMA (1) that physicians may continue to bill and be paid for their
professional component of purchased diagnostic tests (as defined by Medicare); and (2) to
strongly encourage physicians to report and document these services accurately, using
appropriate CPT codes for interpretation or other professional services. (CMS Rep. N, A-90;
Reaffirmed: Sunset Report, I-00)