Medicare Physician Fee Schedule

The Medicare Access and CHIP Reauthorization Act (MACRA) was signed in April 2015. 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 November 2, 2017, the Centers for Medicare & Medicaid Services (CMS) released a final rule that changes the Medicare physician fee schedule (MPFS) and other Medicare Part B payment policies for calendar year 2018. The policies are effective on January 1, 2018. The AAFP prepared a summary of the final rule to prepare members for 2018.

On July 12, CMS released the eagerly anticipated Medicare physician fee schedule(s3.amazonaws.com), which also includes new information on MACRA implementation. The proposed rule would make changes to outpatient Medicare Evaluation and Management requirements by collapsing levels 2-5 under one standard for documentation, and proposes add-on payments for E/M codes.

As part of this proposed rule, CMS posted a press release(www.cms.gov), a fact sheet(www.cms.gov), and a (www.cms.gov)fact sheet specific to Year 3 of the Quality Payment Program (QPP). During a call on July 12, CMS Administrator Seema Verma noted the rule would save 51 hours per physician per year conducting medical documentation, and the E/M payment change is budget neutral.

In addition, there are important changes to telemedicine payment designed to make it easier to send images, allow for virtual check-ins, and more easily bill for telephonic and video services. The AAFP is reviewing the proposal, will create a summary for members, and will submit comments to the agency before the September 10, 2018 deadline.

Read the initial summary of the 2019 proposed schedule from the AAFP »(2 page PDF)

Webcast: CMS Briefing on 2019 Proposed Rule


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