Skip to Main Content

Physician Fee Schedule

CY 2015 Physician Fee Schedule Final Rule with Comment Period

The CY 2015 PFS final rule with comment period was placed on display at the Federal Register on October 31, 2014. In addition to policies affecting the calculation of payment rates, this final rule identifies potentially misvalued codes, adds procedures to the telehealth list, establishes a payment rate and includes a scope of service element related to electronic health records for chronic care management services for CY 2015, and finalizes a change in the process used for establishing rates to increase transparency. This rule also addresses the value-based payment modifier and the physician feedback reporting program, and includes updates to the ambulance fee schedule, clinical laboratory fee schedule, federally qualified health center and rural health clinic payment systems, physician compare website, physician quality reporting system, electronic prescribing (ERX) incentive program, and Medicare shared savings program.

CY 2015 Physician Fee Schedule Proposed Rule with Comment Period

The CY 2015 PFS proposed rule with comment period was placed on display at the Federal Register on July 3, 2014. In this major proposed rule, we propose RVUs for CY 2015 and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. In addition to policies affecting the calculation of payment rates, this proposed rule proposes potentially misvalued codes, adding procedures to the telehealth list, a process for added transparency in development of payment rates, and provisions relating to implementation of  separate payment for chronic care management services.

In addition the rule includes proposals and updates related to the ambulance fee schedule regulations, the Physician Compare Website, the Physician Quality Reporting System, the Medicare Shared Savings Program and the Value-Based Payment Modifier and the Physician Feedback Program.

CY 2014 Physician Fee Schedule Final Rule with Comment Period

The CY 2014 PFS final rule with comment period was placed on display at the Federal Register on November 27, 2013. In addition to policies affecting the calculation of payment rates, this final rule identifies potentially misvalued codes, adds procedures to the telehealth list, modifies the telehealth originating site definitions, finalizes a policy for chronic care management services for CY 2015, applying therapy caps to outpatient therapy services furnished by CAHs, requires the compliance with state law as a condition of payment for services furnished incident to physician and other practitioner services.  This final rule includes discussions and policy regarding revising the MEI based on MEI TAP recommendations, budget neutrality for the chiropractic services demonstration, physician value-based payment modifier and the physician feedback reporting program, and updating the Ambulance Fee Schedule regulations, Clinical Lab Fee Schedule, physician compare website, physician quality reporting system, electronic prescribing (ERX) incentive program, and Medicare shared savings program.

CY 2014 Physician Fee Schedule Proposed Rule with Comment Period

The CY 2014 PFS proposed rule with comment period was placed on display at the Federal Register on July 08, 2013.  In this major proposed rule, we propose RVUs for CY 2014, updates to the geographic practice cost indexes and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. In addition to policies affecting the calculation of payment rates, this proposed rule proposes potentially misvalued codes, adding procedures to the telehealth list, modifying the telehealth originating site definitions, proposes new codes for complex chronic care management for CY 2015, applying therapy caps to outpatient therapy services furnished by CAHs, requiring the compliance with state law as a condition of payment for services furnished incident to physician and other practitioner services.

This proposed rule includes discussions and proposals regarding revising the MEI based on MEI TAP recommendations, budget neutrality for the chiropractic services demonstration, physician value-based payment modifier and the physician feedback reporting program, and updating the Ambulance Fee Schedule regulations, physician compare website, physician quality reporting system, electronic prescribing (ERX) incentive program, and Medicare shared savings program.

CY 2013 Physician Fee Schedule Final Rule Correction Notice

The CY 2013 PFS final rule correction notice was published in the Federal Register on August 12, 2013. The correction notice corrects technical errors and typographical errors in the final rule with comment period that was published in the November 1, 2012 Federal Register.

CY 2013 Physician Fee Schedule Final Rule with Comment period

The CY 2013 PFS final rule with comment period was placed on display at the Federal Register on November 1, 2012.  The final rule with comment period addresses changes to the physician fee schedule, payments for Part B drugs, and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. It also implements provisions of the Affordable Care Act by establishing a face-to-face encounter as a condition of payment for certain durable medical equipment (DME) items. In addition, it implements statutory changes regarding the termination of non-random prepayment review. This final rule with comment period also includes a discussion in the Supplementary Information regarding various programs.

The MPFS Conversion Factor for CY 2013 is $34.0230, which reflects the zero percent update for calendar year 2013 adopted by section 601(a) of the American Taxpayer Relief Act of 2012 and MPFS payment rates reflecting policies adopted in the CY 2013 Medicare Physician Fee Schedule Final Rule that appeared in the Federal Register on November 16, 2012, as subsequently corrected by a CY 2013 Medicare Physician Fee Schedule Final Rule Correction Notice.

CY 2013 Physician Fee Schedule Proposed Rule

The CY 2013 PFS proposed rule was placed on display at the Federal Register on July 6, 2012. The proposed rule includes proposed annual updates to the relative weights of physician services and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services.

CY 2012 Physician Fee Schedule Final Rule Correction Notice

The CY 2012 PFS final rule correction notice was published in the Federal Register on January 4, 2012. The correction notice corrects technical errors and typographical errors in the final rule with comment period entitled ‘‘Medicare Program; Payment Policies under the Physician Fee Schedule, Five-Year Review of Work Relative Value Units, Clinical Laboratory Fee Schedule: Signature on Requisition, and Other Revisions to Part B for CY 2012'' which appeared in the November 28, 2011 Federal Register.

CY 2012 Physician Fee Schedule Final Rule With Comment Period

The CY 2012 PFS final rule with comment period was placed on display at the Federal Register on November 28, 2011. The final rule with comment period addressed changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. The final rule with comment period implemented or discussed certain statutory provisions including provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. In addition, this final rule with comment period discussed payments for Part B drugs; Clinical Laboratory Fee Schedule: Signature on Requisition; Physician Quality Reporting System; the Electronic Prescribing (eRx) Incentive Program; the Physician Resource-Use Feedback Program and the value modifier; productivity adjustment for ambulatory surgical center payment system and the ambulance, clinical laboratory, and durable medical equipment prosthetics orthotics and supplies (DMEPOS) fee schedules; and other Part B related issues.

The final rule with comment period was published in the November 28, 2011 Federal Register, and the comment period closed on January 3, 2012.

Calculating Payment Amounts

The formula for calculating 2012 physician fee schedule payment amount is as follows:

2012 Non-Facility Pricing Amount =
[(Work RVU * Work GPCI) +
(Transitioned Non-Facility PE RVU * PE GPCI) +
(MP RVU * MP GPCI)] * Conversion Factor (CF)

2012 Facility Pricing Amount =
[(Work RVU * Work GPCI) +
(Transitioned Facility PE RVU * PE GPCI) +
(MP RVU * MP GPCI)] * CF

The conversion factor for CY 2012 is $34.0376.

Physician Center

For a one-stop resource web page focused on the informational needs and interests of Medicare Fee-for-Service (FFS) physicians, go to the Physician Center (see under "Related Links Inside CMS" below).