2015 Medicare Fee Schedule Finalized

The 2015 Medicare Physician Fee Schedule (PFS) goes into effect April 1, 2015. While the current Medicare Fee Schedule stays around until March 31, 2015, the new PFS will bring a 20-plus percent drop in physician reimbursement unless Congress steps in first. While Congress has reversed the cuts in previous years, there’s truly no guarantee that Congress will take action prior to the spring decline.

With Medicare the bellwether for our industry, let’s take a look at the highlights of the new schedule and how it will affect your reimbursement in 2015.

Chronic care management. The Centers for Medicare and Medicaid Services (CMS) will begin reimbursing physicians for chronic care services with dates of service of January 1, 2015. Instead of creating a new G code, CMS will use the established CPT® code, 99490, which will pay approximately $40. The code is applicable to non-face-to-face services related to managing the care of a Medicare patient with two or more chronic conditions, and can be used by a physician of any specialty. Practices must be using a certified EHR system to qualify, but the work can be performed by staff under “general” supervision of the physician. While $40 may not sound like much, the code is billable each calendar month for 20 minutes or more of activity, making it potentially lucrative.

Specialty cuts. The 2015 PFS brings cuts to a handful of physician specialty services. Radiation therapy centers and payments for radiation oncology escaped a massive cut, based on CMS’s desire to classify equipment costs as indirect rather than direct practice expenses. This reclassification is expected to be addressed in the 2016 fee schedule. The only specialties with negative impacts of more than one percent will be dermatology and ophthalmology, each incurring a two percent reduction due to resource value scale (RVS) adjustments.

Screening colonoscopies. Medicare beneficiaries no longer must pay for anesthesia provided separately during a screening colonoscopy. As of January 1, 2015, the deductible and coinsurance are both waived as CMS rewrites its definition of the screening service to include separately provided anesthesia.

PQRS measures. Physicians and other eligible professionals must report on nine measures in 2015 for the Physician Quality Reporting System (PQRS). Successful reporting avoids the two percent penalty that will be imposed in 2017 based on 2015 participation. No more bonus payments are available through this government initiative; it converts to a penalty-based program in 2015.

Value-Based Payment Modifier (VBPM). After starting with the large practice market in 2014, this initiative will be rolled out to all practices next year. Physicians, regardless of practice size, must report it or face negative payment adjustments. The penalty increases to four percent for practices with 10 or more eligible professionals, but even smaller practices should take heed as CMS’s definition of an eligible professional (EP) is quite broad.

Global periods. The 2015 PFS confirms the phase-out of the global period for surgery codes – 10- and 90-days. When finally eliminated in 2018, all global periods will be replaced by 0-day global codes, thus migrating all surgeries and procedures into per-service coding.

The full package of Medicare physician fee schedule changes coming in 2015 is packed into the Final Rule. Expect your specialty society, if it hasn’t already done so, to release its assessment of the new rule’s impact on your practice.