2017 MPFS Proposed Rule: Which Changes Are in the Spotlight?

Primary care and diabetes prevention — Those are the buzz words flying around CMS’s proposed changes to the Physician Fee Schedule for 2017. Here’s a snapshot of the proposed rule.

CMS Changes Fee Schedule to Promote Primary Care

According to a CMS announcement, one step the agency is taking to recognize primary care work for Medicare beneficiaries is to provide separate payment for care management and cognitive work instead of bundling payment for that work into E/M codes. The goal is to be sure payment for the services reaches the providers actually performing the work.

Proposals include separate payments for the following:

  • Existing non-face-to-face prolonged E/M services (and new values for existing face-to-face prolonged E/M services)
  • New assessment and care planning codes for patients with dementia or other cognitive impairments
  • New interprofessional care management codes for patients with behavioral health conditions
  • New codes for resource costs related to treating patients with mobility-related impairments
  • Codes for complex chronic care management (and a reduction in red tape, too).

Diabetes Prevention Program May See Medicare Expansion

Acccepting the truth of the old adage that an ounce of prevention is worth a pound of cure, CMS has proposed to expand the Diabetes Prevention Program into Medicare. This would begin Jan. 1, 2018, with the time in between used to work on details such as how to enroll program organizations in Medicare, payment structure, and claims submission, as well as defining eligible pre-diabetic patients.

The program combines 16 intensive classroom-style sessions on nutrition, physical activity, and behavior changes followed by monthly check-ins to help with maintenance.

The Proposed Rule Packs In Even More Changes, Of Course

Some of the other payment provision areas CMS is emphasizing in the proposed rule include the following:

  • Misvalued services: Remember how the conversion factor got dropped in 2016 in part because of misvalued services calculations? CMS indicates the 2017 rule should avoid that issue by meeting the misvalued code changes goal for the year.
  • Moderate sedation: The proposed rule discusses values for moderate sedation codes and the need to get a handle on sedation patterns for endoscopy.
  • Telehealth: CMS may add certain ESRD dialysis, advanced care planning, and Medicare G code critical care services to the list of telehealth eligible services. We may see a new place of service code for telehealth, too.
  • Mammograms: In the future, we may see new codes for mammography to better reflect current use of digital imaging and computer-aided detection.
  • GPCI: Expect to see some changes to the Geographic Practice Cost Indices, including potential payment increases in Puerto Rico and urban California.
  • Global surgical package: In addition to including a data collection strategy to value post-surgical services (to better inform the debate about transforming all 10- and 90-day global codes to 0-day), the proposed rule lists 83 services with 0-day globals to review. The reason given for the latter is that a large number of claims report an E/M along with those 83 services despite the global-day restrictions.

Act now: CMS is accepting comments until Sept. 6, 2016, for the proposed rule.

How About You?

Were you surprised by anything in the proposed Medicare Physician Fee Schedule 2017? Is there anything you hope won’t make it into the final rule? Or are you most concerned with what ends up in the CMS Physician Fee Schedule lookup?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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