CMS Announces Proposed Rules to Physician Fee Scheduled for 2015

CMSOn July 3rd, the Centers for Medicare and Medicaid Services (CMS) issued proposed changes to the Medicare physician fee schedule. Making announcements the day before a major holiday is a common approach used by government agencies and corporations to reducing attention.

The press release noted that the  (PAMA) of 2014 provides for a zero percent PFS update for services provided between Jan. 1, 2015 and March 31, 2015. This rate is set by Congress not CMS and the final figures will be announced along with the final rule in November. The sustainable growth rate formula is also unchanged as that calculation is determined under a statutory formula set by Congress.

Highlights from the proposed fee schedule include:

  • Proposing a payment rate of $41.92 for the chronic care management code, which can be billed only once per month per patient. The agency also stated that it will propose to "allow greater flexibility in the supervision of clinical staff providing CCM services."
  • Changes to the global surgery code. CMS is "proposing to transform all 10- and 90-day global codes to 0-day global codes beginning in calendar year 2017,"  The agency plans to have one code for services provided on the day of surgery, and pay separately for postsurgical services. This change follows a report by the Office of the Inspector General that identified a number of surgical procedures "that include more visits in the global period than are being furnished."
  • Adding annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management services to telehealth services.
  • Changes to the new program, Open Payments, to disclose ties between providers and pharmaceutical and device companies. Among other changes, CMS is proposing to remove an exclusion for reimbursement related to continuing medical education. "Eliminating the exemption for payments to speakers at certain accredited or certifying continuing medical education events will create a more consistent reporting requirement, and will also be more consistent for consumers who will ultimately have access to the reported data," the agency noted. CMS also wants manufacturers to report stocks, stock options, and other ownership interests as separate categories because "this will enable us to collect more specific data regarding the forms of payment made by applicable manufacturers."

CMS will be accepting comments on the proposed rule until Sept. 2.

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