2017 Physician Fee Schedule Proposed Rule Released

This afternoon, the Centers for Medicare and Medicaid Services (CMS) issued its proposed 2017 payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) and policies set forth in these rules are effective Jan. 1, 2017. Comments are due to CMS on September 6, 2016
Physician Fee Schedule
Overall Proposed Rule Impact

CMS is proposing a number of coding and payment changes to better identify and pay for primary care, care management, and cognitive services:
  • Make separate payments for certain existing CPT that pay for non face to face evaluation and management services
  • Revalue existing CPT codes for existing face to face services.
  • Make separate payment for care planning for patients with cognitive impairment
  • Make separate payment for primary care practices that use interprofessional care to treat patients with behavioral health conditions.
  • Make separate payment to recognize increased costs of furnishing visits to patients with mobility impairment.
  • Separate payment for chronic care management for patients with greater complexity
  • Several changes to reduce administrative burden with chronic care management.
Appropriate Use Criteria (AUC) Program for Advanced Diagnostic Imaging Services

§218 of the Protecting Access to Medicare Act of 2014 (PAMA) established a new initiative that requires clinicians to consult with appropriate use criteria using a clinical decision support tool prior to payment for advanced diagnostic imaging services.
CMS previously established a process for requiring evidence-based processes for determining who may develop and maintain appropriate use criteria. CMS determined that qualified provider-led entities may develop AUC and determined 11 entities who have the authority to develop AUC. This year's rule focuses on proposals for priority clinical areas, requirements for clinical decision support mechanisms (CDSM) and exceptions for clinicians for whom reporting may present a significant hardship. CMS indicates in the rule that the requirement that physicians report using a CDSM will not begin before January 1, 2018
Misvalued Codes
CMS has proposed codes with a .51 net expenditure reduction. If finalized, these changes in potentially misvalued codes would meet the statutory target of .5 percent and would avoid an overall reduction to physician fee schedule services.  CMS has not identified 78452 as a potentially misvalued code.
To access a fact sheet on the PFS proposed rule CLICK HERE
To view the PFS proposed rule in its entirety CLICK HERE