Medicare program; revisions to payment policies under the physician fee schedule for calendar year 2004. Final rule with comment period

Fed Regist. 2003 Nov 7;68(216):63195-395.


This final rule will refine the resource-based practice expense relative value units (RVUs) and make other changes to Medicare Part B payment policy. The policy changes concern: Medicare Economic Index, practice expense for professional component services, definition of diabetes for diabetes self-management training, supplemental survey data for practice expense, geographic practice cost indices, and several coding issues. In addition, this rule updates the codes subject to the physician self-referral prohibition. We also make revisions to the sustainable growth rate and the anesthesia conversion factor. These changes will ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. We are also finalizing the calendar year (CY) 2003 interim RVUs and are issuing interim RVUs for new and revised procedure codes for CY 2004. As required by the statute, we are announcing that the physician fee schedule update for CY 2004 is -4.5 percent, the initial estimate of the sustainable growth rate for CY 2004 is 7.4 percent, and the conversion factor for CY 2004 is $35.1339. We published a proposed rule (68 FR 50428) in the Federal Register on Part B drug payment reform on August 20, 2003. This proposed rule would also make changes to Medicare payment for furnishing or administering certain drugs and biologicals. We have not finalized these proposals to take into account that the Congress is considering legislation that would address these issues. We will continue to monitor legislative activity that would reform the Medicare Part B drug payment system. If legislation is not enacted soon on this issue, we remain committed to completing the regulatory process.

MeSH terms

  • Centers for Medicare and Medicaid Services, U.S.
  • Fee Schedules / economics*
  • Fee Schedules / legislation & jurisprudence
  • Humans
  • Medicare Part B / economics*
  • Medicare Part B / legislation & jurisprudence
  • Prospective Payment System / economics*
  • Prospective Payment System / legislation & jurisprudence
  • Relative Value Scales*
  • United States