Medicare Physician Fee Schedule

In April 2015, the President signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (HR 2, also known as MACRA). This law:

  • Repeals the Sustainable Growth Rate (SGR) methodology for determining updates to the Medicare physician fee schedule.
  • Establishes annual positive or flat fee updates for 10 years and institutes a two-tracked fee update afterwards.
  • Establishes a Merit-Based Incentive Payment System that consolidates existing Medicare fee-for-service physician incentive programs.
  • Establishes a pathway for physicians to participate in alternative payment models, including the patient-centered medical home.
  • Makes other changes to existing Medicare physician payment statutes.

On July 7, the Centers for Medicare & Medicaid Services (CMS) released the 2017 proposed Medicare physician fee schedule(www.gpo.gov). Of particular significance to primary care physicians, CMS proposes increased payments for several care management services. Specifically, the regulation includes proposals to pay for:

  • Non-face-to-face prolonged evaluation and management services
  • Comprehensive assessment and care planning for patients with cognitive impairment
  • Primary care practices to use interprofessional care management resources to treat behavioral health conditions
  • Resource costs of furnishing visits to patients with mobility-related impairments
    Chronic care management (CCM) for patients with greater more complex conditions

In addition, CMS proposes to reduce the administrative burden associated with the CCM codes to eliminate potential barriers to furnishing and billing for these services. CMS also will revalue existing CPT codes describing face-to-face prolonged services.

For 2017, CMS estimates the conversion factor to be $35.7751, which is slightly lower than the 2016 conversion factor of $35.8043. However, compared to all other specialties, family physicians are projected to receive an estimated 3-percent increase in Medicare allowed charges based on the provisions of the propose rule. This increase is the largest estimated update for a specialty.

CMS also proposes to add several codes to the list of services eligible to be furnished via telehealth, including Advance Care Planning (ACP) services and critical care consultations furnished via telehealth using new Medicare G-codes.

The AAFP is currently analyzing the regulation, preparing a summary, and will provide detailed comments to CMS before the due date of September 6.


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