CMS Establishes New Physician Specialty Code for Interventional Cardiology

The Centers for Medicare & Medicaid Services has announced (pdf) the establishment of a new physician specialty code for interventional cardiology: C3.

According to an American College of Cardiology report, C3 "allows CMS to distinguish an interventional cardiologist from a clinical cardiologist when billing for Medicare services."

Previously, no such mechanism existed. As a result, ACC reports that some local Medicare carriers denied claims when a cardiologist and an interventionalist from the same group practice billed for patient evaluation services, citing duplicate billing.

C3 allows for the reporting of the involvement of two specialty physicians providing distinct services to an individual patient.

In addition to the establishment of the new C3 code, CMS also created a new non-physician specialty code for restricted use: C4.

Changes were also made to the description of specialty code 62, and the names associated to specialty codes 88 and 95 were updated.

The effective date for these changes in January 1, 2015, while the implementation date is January 5, 2015.

Access an MLN Matters Special Edition Article on these code changes detailed in Change Request 8812 (pdf).

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