Medicare restructured the way pathologists were compensated about 20 years ago and it has remained stable since (except for the fact that they have ratcheted down the amount of money per billing code to where it is now at 35% what is was in the 80s). The deal was that we would bill per container received. If one patient had 10 containers in one case, we could bill the appropriate code for each container (most commonly 88305). Well now medicare wants to change it so that starting next year we can only bill one (to at most two codes) per patient for any given day. What this means is that if we could make $350 on those ten skin biopsies ($35 per container) for one case, now we will only make $35-$70 (one-two codes for the patient that day). If this goes through, pathologists incomes are going to get slashed enormously (insurance companies will follow suit as they have done so for the last 20 years). This will be a huge blow to private practice and academic centers and anyone else who is compensated by medicare or insurance. I suppose Kaiser pathologists will be safe. If those goes through, get out of path. This is way more of a threat to pathologists than even the path mills who are willing to split fees with big GI, Derm or uro groups to read their slides. Please contact CAP and let them know this has to be their #1 focus. Here is the memo that is www.cap.org. College Develops Response to Units of Service Limitations The College is reviewing closely and will comment on a Medicare contractor's proposal for units of service limits, called "medically unbelievable edits" by the Centers for Medicare and Medicaid Services (CMS), that appear to have been developed without regard to current coverage or policy guidelines. Under the proposal, recently provided to the CAP and other specialty societies for review, local carriers would use the edits to test claims for a beneficiary on a given date of service against a limit for units of service. CMS has stated that the edits are intended to catch "typographical errors and unbelievable cases" submitted to Medicare for payment. The edits, whose use will result in automatic denials of all claimed units in excess of the criteria units of service ceiling, are far-reaching: They affect the majority of pathology services and include CPT codes for all other specialties. Of particular concern to pathologists is the document's proposed limit of two units for CPT 88305 (Level IVSurgical Pathology, Gross and Microscopic Exam) on claims for the same beneficiary on the same date of service for a given provider. There is a 45-day comment period on the edits, with comments due by mid-January. "We are actively reviewing the proposed edits to identify necessary modifications to the MUE list and are working now on a firm response," said Mark S. Synovec, MD, FCAP, Chair of the CAP Economic Affairs Committee. "We will develop clinical evidence of why these unit limitations are clearly inappropriate for pathology and pursue other measures, as appropriate, to fight this process, which appears to be seriously flawed." Comments on the proposed MUE file could result in modifications or deletions. Use of the MUEs is proposed to start in July 2006.