2016 Proposed Medicare Physician Fee Schedule

AAFP Lauds Payment Stability, Action on Advance Care Planning Codes

July 13, 2015 04:04 pm News Staff

The AAFP and family physicians across the country recently got a look at what Medicare payment may look like next year with the July 8 release of CMS' proposed 2016 Medicare physician fee schedule, now available for public review.(s3.amazonaws.com)


The 815-page document is set for official publication in the Federal Register(www.federalregister.gov) on July 15.

In an Academy news release posted on the day the proposal was released, AAFP President Robert Wergin, M.D., of Milford, Neb., heralded the 2016 fee schedule as the "beginning of health security for millions of elderly and disabled Americans who depend on Medicare."

He noted that the 2016 proposal marked the first time in many years that physicians would not face "double-digit" cuts in their Medicare payment because of the unpopular and disruptive sustainable growth rate (SGR) formula. After years of effort on the part of the AAFP and other stakeholders, the SGR finally was repealed in April with passage of the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act.

Story Highlights
  • CMS recently released its 2016 proposed Medicare physician fee schedule, which includes a modest increase in physician payment and action on advance care planning codes.
  • AAFP President Robert Wergin, M.D., noted that the 2016 fees schedule marked the first time in 13 years that physicians wouldn't face the threat of double-digit cuts in Medicare payment.
  • In coming days, the AAFP will scour the fee schedule and submit a detailed response to CMS before the Sept. 8 deadline for public comment.

"Instead of facing a devastating Medicare cut in payment for the care they provide, physicians will see a modest increase," said Wergin. "But most important, physicians can focus on caring for their patients, and their patients can rest assured their care will not be interrupted."

Wergin pointed out that the AAFP's strong advocacy also played a key role in the establishment of advance care planning codes that aim to pay physicians for their expertise and time in assisting patients and families with advance care planning services, including the development of patient care plans.

He affirmed that the Academy would work relentlessly on members' behalf to ensure that the two related CPT codes -- 99497 and 99498 -- were included as active codes in the 2016 fee schedule.

In a separate press release from CMS,(www.cms.gov) the agency's acting administrator, Andy Slavitt, said the proposed 2016 fee schedule included provisions focused on patient-centered care and a Medicare program based on quality care and healthy outcomes for patients.

"CMS is building on the important work of Congress to shift the Medicare program toward a system that rewards physicians for providing high quality care," said Slavitt.

Release of the fee schedule triggers a 60-day comment period during which AAFP staff members will scour the document for provisions that would most impact family physicians and their patients. The AAFP's response to CMS likely will include comments related to a number of issues, including CMS' proposals to

  • establish separate payment for advance care planning CPT codes 99497 and 99498,
  • set the 2016 Medicare conversion factor at $36.1096,
  • improve payment accuracy for primary care and care management services,
  • investigate expansion of the Comprehensive Primary Care initiative, and
  • amplify efforts to develop the value-based payment modifier program that provides enhanced payment to physicians based on the quality and cost of care they furnish to traditional Medicare beneficiaries.

Stay tuned. CMS will accept public comments on the proposed fee schedule until Sept. 8; family physicians can rest assured that the AAFP will submit a detailed and informed response that keeps members' best interests at the forefront.

Related AAFP News Coverage
Physicians Dodge Medicare Pay Cut After AAFP Puts Up Fight

'Care Planning Act' Gets Big Thumbs Up From AAFP
Bill Would Safeguard Medicare Beneficiaries' End-of-Life Wishes


Getting Paid for Advance Care Panning
Organizations Prod HHS to Recognize Existing CPT Codes


More From AAFP
Comprehensive Primary Care Initiative

Family Practice Management's Getting Paid blog: CMS considers separate payment for advance care planning

Additional Resource
CMS Fact Sheet: 2016 Proposed Medicare Physician Fee Schedule(www.cms.gov)