Physician Practice

2017 Medicare Physician Fee Schedule a win for physicians

Physician Practice Insider, November 29, 2016

Physicians should see an increase in Medicare payments in the 2017 Medicare Physician Fee Schedule (MPFS). The addition of new codes presented in the MPFS could open up nearly $140 million in increased payments to most physicians in 2017, the American Academy of Family Physicians (AAFP) said. But, along with increased payments, primary care physicians may struggle to stay on top of requirements in a year that will already be seeing sweeping changes as the industry ramps up for the full implementation of the Merit-based Incentive Payment System(MIPS) in 2018.

The final rule updates and revises the basic measures that support physician reimbursement: CPT® and HCPCS codes, relative value units (RVU), and other policies and programs. RVUs help CMS measure the resources used to provide a specific service and are broken into three categories: work, practice expense, and malpractice expense. Although the annual changes to RVUs must be budget neutral for CMS, that may not be the case for all physicians. Certain specialties may feel the double impact of decreased payments tied to RVUs as well as budget changes to other programs, CMS said in the final rule.

In the 2017 MPFS files, CMS included a table comparing the 2016 and 2017 value of affected CPT®/HCPCS codes and the impact of the final rule. CMS calculates that most will experience no change or a minor increase between 1%-2%. However, CPT code 93458 (coronary angiography with left heart cathertization including intraprocedural injection(s) for left ventriculography, when performed) will pay 4% less, down to $310.44 in 2017 from $323.31 in 2016. And code 43239 (esophagogastroduodenoscopy with biopsy, single or multiple) will pay 14% less in 2017. The code will pay $349.20 (non-facility) in 2017, but paid $403.87 in 2016.

The final rule also finalizes coding changes the agency says will help clarify differences between primary care, care management, and cognitive services, as well as telehealth services. For example, table nine—proposed global service codes, defines sets of G-codes for physician office settings, telehealth services, and facility settings. These codes, reported in ten-minute increments, are part of global packaging for post-operative care. Telehealth services will be billable for an expanded range of services, including advanced care planning and end-stage renal disease services related to dialysis.

The AAFP praised some aspects of the final rule that would give physicians a bump in payments. New and revised codes will increase CMS’ payments to physicians overall by roughly $140 million and over time could see $4 billion in increased payments, the AAFP said.

Other changes singled out for praise by the AAFP include the expansion of the Medicare Diabetes Prevention Program.

The AAFP was critical of CMS’ efforts to identify potentially misvalued services, leading a lower mandatory adjustment. CMS identified potentially misvauled codes including:

  • 11755—biopsy of finger or toe nail
  • 20612—aspiration and/or injection of cysts
  • 29105—application of long arm splint
  • G0168—wound closure utilizing tissue adhesive(s) only

Changes to the appropriate use criteria (AUC) for advanced diagnostic imaging services also drew the AAFP’s criticism. The policy is intended to help physicians select appropriate services when ordering certain imaging services. The AAFP believes the policy places a disproportionate burden on primary care physicians and lobbied CMS to delay the policy so it could be aligned with MIPS. The 2016 MPFS defined AUCs and created guidance for developing, modifying, or endorsing AUCs. The 2017 MPFS establishes exceptions and defines physicians that are exempted from AUCs.

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