Improve the health of the people of Wisconsin by supporting and strengthening physicians' ability to practice high-quality patient care in a changing environment.

CMS releases Medicare physician fee schedule final rule

The Centers for Medicare and Medicaid Services (CMS) last week released the 2017 Medicare physician fee schedule (PFS) final rule, which includes a .5 percent physician increase that was part of the Medicare Access and CHIP Reauthorization Act (MACRA).

CMS also finalized the addition of several codes to the list of services eligible to be furnished via telehealth, including two advance care planning (ACP) codes. This means physicians will be compensated for the time it takes to have an ACP conversation and will be in a better position to coordinate care for Medicare beneficiaries. In comments submitted in September, the Society thanked CMS for its continued support of ACP and the proposal to add these ACP services to the telehealth list.

Also significant in the final rule is that CMS greatly modified its proposal to collect data on 10- and 90-day global codes, which will be effective for services related to global procedures furnished on or after July 1, 2017. CMS will now require reporting of postoperative visits only for high-volume/high-cost procedures, will use the existing CPT code, and will only require a sample of clinicians to report if they are in groups of 10 or more.

The final PFS also includes significant payment improvements for primary care and patient-centered care management. Specifically, CMS created new codes that separately pay for transitional care management and chronic care management services. CMS finalized:

  • Creating separate payments for certain non-face-to-face prolonged evaluation and management services.
  • Creating separate payment for behavioral health integration.
  • Creating separate payments for codes describing chronic care management for patients with greater complexity.
  • Making separate payments using new codes to describe the comprehensive assessment and care planning for patients with cognitive impairment (e.g., dementia).

In spite of these positive actions, CMS again failed to correct the Geographic Practice Cost Index (GPCI) for Wisconsin. It did, however, revise the methodology used to calculate GPCIs for U.S. territories, which will increase the overall PFS payments in Puerto Rico. The Society will continue to work to address this discrepancy, meeting with Speaker Paul Ryan’s staff next week.

For more information, contact Chris Rasch, the Society’s director of state and federal relations.

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