Summary Medicare Physician Fee Schedule Payments

On Oct. 30, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a Final Rule (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.

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

View the full McKesson summary for emergency medicine and emergency medical services (PDF, 271 KB).

1 Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2016 (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, McKesson Business Performance Services.