On October 31, 2014, CMS issued the Calendar Year 2015 Medicare Physician Fee Schedule Final Rule.

The final rule is available online until its publication in the November 13th Federal Register.

Some of the highlights of the final rule are as follows:

Payment rate

The final rule includes a 21.2 percent reduction in Medicare physician payment rates beginning April 1, 2015. The moratorium on reductions in Medicare Part B physician payments included in the Protecting Access to Medicare Act expires March 31, 2015. The conversion factor for January 1 through March 31, 2015 will be US$35.8013, and unless a change in law will decrease to US$28.2239, effective April 1.

Primary care and chronic care management

CMS continues to emphasize primary care, including in the final rule separate payment for chronic care management (“CCM”) services; that is, non-face-to-face services to Medicare beneficiaries who have multiple, significant, chronic conditions (two or more).  CCM services include regular development and revision of a plan of care, communication with other treating health care professionals, and medication management. CCM can be billed once per month per qualified patient at a payment rate of US$40.39.

Global surgery

Surgeons are paid a single global fee that, depending on the procedure, includes the value of surgical procedure and post-surgery visits for up to 10 days or 90 days. The Department of Health and Human Services’ Office of Inspector General has identified a number of surgical procedures that include more visits in the global period than are regularly being furnished. In response, CMS will transform all 10-day global codes to zero-day global codes beginning in CY 2107 and all 90-day global codes to zero-day global codes in CY 2018. As CMS begins revaluation of services subject to zero-day global periods, it will assess whether there is a better construction of a bundled payment for surgical services that incentivizes care coordination and care redesign across an episode of care.

Services performed in on-campus provider-based departments

CMS will collect data on professional services furnished in off-campus outpatient departments by requiring physicians and other practitioners to report these services using a new place of service code on Form CMS-1500s. This requirement is elective in 2016 and strictly required in 2016.  CMS is also requiring hospitals to bill outpatient services furnished in off-campus outpatient departments using a specific modifier.

Access to telehealth services

CMS is adding to the list of services that can be furnished to Medicare beneficiaries under the telehealth benefit the following: annual wellness visits (including a personalized prevention plan of service, initial visit and subsequent visit), psychoanalysis (including family psychotherapy), and prolonged evaluation and management services.

Physician Quality Reporting System (“PQRS”)

The PQRS is a pay-for-reporting program that uses a combination of incentive payments and downward payment adjustments to promote reporting of quality information by eligible professionals.  The final rule adds 20 new individual measures and 2 measure groups and removes 50 measures from reporting.

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