CMS releases 2017 Medicare Physician Fee Schedule proposed rule

July 8, 2016
Medicare Web

CMS released the 2017 Medicare Physician Fee Schedule (MPFS) proposed rule yesterday, with policies that look to expand an Innovation Center program, revise payment for care management services, and collect data regarding global period payments.

The agency is proposing to expand the Innovation Center’s Diabetes Prevention Program for all Medicare beneficiaries beginning January 1, 2018. The program includes 16 core sessions provided in a classroom-style setting with training on dietary and behavioral changes for patients. These are followed up with monthly meetings to ensure beneficiaries maintain these changes. CMS is seeking comment on provider enrollment, payment structures, and beneficiary eligibility on the program.

Another goal of the proposed rule is to improve payment accuracy for primary care, care management, and patient-centered services. CMS is looking to make separate payment for many provider services in these areas, instead of bundling it with E/M visit codes that all specialties use.

After CMS’ plan to eliminate global surgery periods in the 2015 MPFS was stopped by Congress in the Medicare Access and CHIP Reauthorization Act of 2015, the agency is looking to begin a  data collection project in order to determine whether such a policy can be put in place. CMS proposes a claims-based strategy for collecting data, as well as surveying 5,000 providers. If the data leads the agency to consider revaluing any services, providers will have a chance to comment in future rulemaking.

In a related proposal, CMS is prioritizing 83 services for review as potentially misvalued due to use with modifier -25 (significant, separately identifiable E/M service by the same physician or other qualified health care professional on the same day of the procedure or other service). The modifier is used to unbundle services provided during an E/M visit, but CMS believes many of the procedures do not qualify as significant, separately identifiable services.

For more information, see CMS' fact sheet. Comments are due by September 6 and a final rule is expected by November 1.