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CMS Proposes Changes to Medicare Physician Fee Schedule

On July 13, CMS issued a proposed rule to update payment policies and rates for services under the Medicare Physician Fee Schedule in 2018. A full list of the proposed changes is available here. They include:

Payments for Off-Campus Provider-Based Hospital Departments

The Bipartisan Budget Act of 2015 requires some services furnished by certain off-campus hospital outpatient provider-based departments to no longer be paid under the Hospital Outpatient Prospective Payment System (OPPS). For 2018, CMS is proposing to reduce current payment rates for these services from 50% to 25% of the OPPS rate.

Medicare Telehealth Services

The proposed rule adds several codes to the list of telehealth services, including:

  • Visit to determine low dose computed tomography eligibility (HCPCS code G0296)

  • Interactive Complexity (CPT code 90785)

  • Health Risk Assessment (CPT codes 96160 and 96161)

  • Care Planning for Chronic Care Management (CPCS code G0506)

  • Psychotherapy for Crisis (CPT codes 90839 and 90840)

Additionally, the rule would eliminate required reporting of a telehealth modifier to reduce administrative burdens on providers.

Care Management Services

CMS is proposing to adopt CPT codes for several care management services currently reported using Medicare G-codes.

New Care Coordination Services and Payment for RHCs and FQHCs

Under the proposal, RHCs and FQHCs could receive payment for regular and complex chronic care management services, general behavioral health integration services, and psychiatric collaborative care model services using two new billing codes exclusively for RHCs and FQHCs. This would be in addition to the per-visit payment.

2018 Value Modifier

To better align incentives and provide a smoother transition to the new Merit-based Incentive Payment System, CMS proposed the following policy changes for the 2018 Value Modifier:

  • Reducing the automatic downward payment adjustment for not meeting minimum quality reporting requirements from:

  • 4% to 2% for groups of ten or more clinicians

  • 2% to 1% for solo practitioners and groups of two to nine clinicians

  • Holding harmless all physician groups and solo practitioners who met minimum quality reporting requirements from downward payment adjustments for performance under quality-tiering for the last year of the program.

  • Aligning maximum upward adjustments to twice the adjustment factor for all physician groups and solo practitioners.

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