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CMS Proposes CY 2016 Medicare Physician Fee Schedule

A proposed rule for the 2016 Medicare Physician Fee Schedule (PFS) would increase physician payment rates by 0.5 percent, add telehealth services for which providers may be reimbursed, and solicit comment on the recently passed payment system alternative to the sustainable growth rate, among other provisions.

The Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2016 proposed rule July 8. Provisions of interest to essential hospitals include these:

  • Payment update: CMS proposes an annual update to the physician payment rate of 0.5 percent.
  • Telehealth services: For CY 2016, CMS proposes to add two telehealth services to those for which Medicare providers may be reimbursed: prolonged service in the inpatient or observation setting (current procedural terminology (CPT) codes 99356 and 99357) and end-stage renal disease related services for home dialysis (CPT codes 90963-90966). CMS also proposes to add certified registered nurse anesthetists to the list of authorized practitioners who may provide telehealth services.
  • Advance care planning: CMS proposes to pay for two services involving advance care planning (CPT codes 99497 and 99498). These services entail voluntarily conversations between patients and their providers about decisions related to end-of-life care.
  • Merit-Based Incentive Payment System (MIPS): The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the law that repealed the sustainable growth rate, created MIPS, an alternative system that adjusts physician payments for composite performance on a set of performance standards. In the proposed rule, CMS seeks general comment on some provisions of MIPS, particularly regarding the low-volume threshold, clinical practice improvement activities, and alternative payment models. CMS also notes that it plans to issue a request for information to solicit additional stakeholder feedback on MACRA requirements.
  • Medicare Shared Savings Program (MSSP): CMS proposes to add one new measure – Statin Therapy for the Prevention and Treatment of Cardiovascular Disease – to align with updated clinical guidelines for the Physician Quality Reporting System and Million Hearts Initiative (the measure would be pay-for-reporting for two years, then transition to pay-for-performance for the third year of the MSSP agreement period). CMS also proposes to adopt a general policy to maintain measures as pay-for-reporting or revert pay-for-performance measures to pay-for-reporting measures, if the measure owner determines the measure no longer meets best clinical practices, or when clinical evidence suggests continued measure compliance might result in patient harm.

Comments are due to CMS by Sept. 8. If you have questions, please contact Beth Feldpush, DrPH, senior vice president of policy and advocacy, at or 202.585.0111.


About the Author

Shahid Zaman is a senior policy analyst at America's Essential Hospitals.

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