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  • Washington Highlights

    CMS Issues Final Physician Fee Schedule Rule for 2018

    Gayle Lee, Director, Physician Payment & Quality

    The Centers for Medicare and Medicaid Services (CMS) Nov. 2 issued the Physician Fee Schedule (PFS) final rule, which would update payment rates and policies for services provided by physicians and other clinicians to Medicare beneficiaries in 2018. The AAMC made several recommendations to CMS in its Sept. 11 comments on the proposed rule [see Washington Highlights, Sept. 15].

    Key highlights from the final rule include:

    • Updating payments under the PFS of plus 0.41 percent for 2018. The final 2018 PFS conversion factor is $35.99 (a slight increase from the 2017 PFS conversion factor of $35.89);
    • Reducing the current PFS payment rates for items and services furnished by certain off-campus hospital outpatient provider-based departments. CMS currently pays for these services under the PFS based on a percentage of the Outpatient Prospective Payment System (OPPS) payment rate. This changes the PFS rate for these services from 50 percent of the OPPS rate to 40 percent of the OPPS rate;
    • Increasing payment for certain office-based behavioral health services by changing the way rates are set;
    • Finalizing a list of Level II Healthcare Common Procedure Coding System (HCPCS) patient relationship modifiers to use on claims to indicate physician relationships with their patients as required under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, P.L. 114-10). Beginning Jan. 1, 2018, the use of these modifiers would be voluntary; and
    • Setting the start date for the Medicare Appropriate Use Criteria (AUC) Program for Advanced Diagnostic Imaging as 2020 and allowing time for education and testing in that initial year.

    CMS issued a fact sheet on the final rule.