CMS announces New Taxonomy Codes for Retina Subspecialty Ophthalmologists

Date: November 24, 2016

Recently, the American Society of Retina Specialists (ASRS) announced that “after years of advocacy,” the National Uniform Claim Committee (NUCC) is establishing a new designation under the Healthcare Provider Taxonomy Code Set for ophthalmologists who are retina providers.  The ASRS noted that this will be released on January 1, 2017, and become effective following a 3-month comment period.  That means an effective date of April 1, 2017 is likely for NUCC.

The Healthcare Provider Taxonomy Code Set is designed to categorize the type, classification, or specialization of health care providers. Whereas many other specialties, such as internal medicine have long had numerous taxonomy code options that provide for a subspecialty identification, ophthalmology has until recently had just one taxonomy code for the entire specialty (specialty 18 – Ophthalmology).  A new taxonomy designation was recently approved for ophthalmic plastic and reconstructive surgeons; that was effective in 2016.

If eventually adopted by CMS (Medicare) and other payers, these new taxonomy designations have possible implications under a number of areas:

  • Under the new CMS Merit-based Incentive Payment System (MIPS), this may allow for retina providers’ Resource Use (Cost) to be tracked separately from ophthalmology as a whole.
  • Also under MIPS, “Quality” reporting measures and benchmarks might eventually be more closely aligned with actual practice patterns and patient disease-types.
  • Under CMS programs focused on patients, such as the “Physician Compare” website, specialties with these designations might be listed separately – as ASRS announced, to “allow accurate comparisons” so that retina patients would make a more-informed choice.
  • ASRS also noted that “network adequacy” issues that have prevented some patients from having access to a wider selection of retinal providers in their area might be alleviated.
  • Consolidated Billing Reports (CBRs) would possibly have better comparative information for providers since some, like oculoplastic and retinal subspecialists, would not now be compared with ophthalmology as a whole in compiled CMS data.

Importantly, remember that the specialty designation (18) remains for ophthalmology even if the new taxonomy codes are adopted – and that adoption of the new taxonomy codes have not taken place yet.

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