Summary Medicare Physician Fee Schedule Payments

On Oct. 30, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a (PDF, 5.6 MB) that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2016. This year, CMS finalized a number of new policies, including several that are a result of recently enacted legislation. In addition, the rule includes discussions regarding:

  • “Potentially Misvalued PFS Codes.
  • Establishing Values for New, Revised, and Misvalued Codes.
  • Target for Relative Value Adjustments for Misvalued Services.
  • Phase-in of Significant RVU Reductions.
  • ‘Incident to’ policy.
  • Portable X-ray Transportation Fee.
  • Updating the Ambulance Fee Schedule regulations.
  • Changes in Geographic Area Delineations for Ambulance Payment.
  • Physician Compare Website.
  • Physician Quality Reporting System.
  • Medicare Shared Savings Program.
  • Electronic Health Record (EHR) Incentive Program.
  • Value-Based Payment Modifier and the Physician Feedback Program.1

The calendar year 2016 PFS final rule is one of several final rules reflecting a broader Administration-wide strategy to create a health care system that results in better care, smarter spending, and healthier people.

A  provided by CMS, discusses the changes to payment policies and payment rates for services furnished under the PFS and other programs.

View the full (PDF, 271 KB).

1 Medicare Program;  (PDF, 17 MB); Final Rule. Nov. 16, 2015. 42 CFR Part 405, 410, 411, et al. Pages 70888-70889.

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About the author

Robert Bunting, CPC, CPC-H, CHC, CEDC, CEMC, CAC is Compliance Director – Emergency Medicine, Studiomaca Business Performance Services.