Physician Fee Schedule

CY 2020 Physician Fee Schedule Final Rule

The CY 2020 Medicare Physician Fee Schedule Final Rule   was placed on display at the Federal Register on November 1, 2019. This final rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2020.

This final rule adds services to the telehealth list. It also updates policies affecting the calculation of payment rates and includes misvalued codes. This final rule aligns the E/M coding and payment with changes recommended by the CPT Editorial Panel and AMA RUC for office/outpatient E/M visits. It also implements Section 2005 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, which creates a new Medicare Part B benefit for Opioid Treatment Programs. The calendar year (CY) 2020 PFS final rule is one of several rules that reflect a broader Administration-wide strategy to create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation.

CY 2020 Physician Fee Schedule Proposed Rule with Comment Period

The  CY 2020 Medicare Physician Fee Schedule Proposed Rule  with comment period was placed on display at the Federal Register on July 29, 2019. This proposed rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2020.

This proposed rule proposes potentially misvalued codes, adds services to the telehealth list and other policies affecting the calculation of payment rates. This proposed rule includes a number of new proposals, including a proposal to align the E/M coding and payment with changes recommended by the CPT Editorial Panel and AMA RUC for office/outpatient E/M visits and implementation of Section 2005 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, which creates a new Medicare Part B benefit for Opioid Treatment Programs. The calendar year (CY) 2020 PFS proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation. CMS will accept comments on the proposed rule until September 27, 2019, and will respond to comments in a final rule. The proposed rule can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection.

CY 2019 Physician Fee Schedule Final Rule

The  CY 2019 Medicare Physician Fee Schedule Final Rule  was placed on display at the Federal Register on November 1, 2018. This final rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2019.

In addition to policies affecting the calculation of payment rates, this final rule finalizes a number of documentation, coding, and payment changes to reduce administrative burden and improve payment accuracy for office/outpatient evaluation and management (E/M) visits over several years. For CYs 2019 and 2020, it finalizes several documentation policies to provide immediate burden reduction, while other changes to documentation, coding, and payment would be implemented in CY 2021. It also finalizes our proposals to pay separately for two newly defined physicians’ services furnished using communication technology. 

Additionally, through an interim final rule with comment period, CMS is implementing a provision from the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act that expands access to telehealth services furnished for purposes of treatment of a substance use disorder or a co-occurring mental health disorder for services furnished on or after July 1, 2019. CMS will accept comments on the interim final rule until December 31, 2018.

CY 2019 Physician Fee Schedule Proposed Rule with Comment Period

The  CY 2019 Medicare Physician Fee Schedule Proposed Rule with comment period  was placed on display at the Federal Register on July 12, 2018. This proposed rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2019.

This proposed rule proposes potentially misvalued codes, adds procedures to the telehealth list and other policies affecting the calculation of payment rates. This proposed rule includes a number of new proposals, including a proposal to change documentation, coding and payment to reduce administrative burden and improve payment accuracy for office/outpatient Evaluation and Management visits, and a proposal to pay separately for two newly defined physicians’ services furnished using communication technology. CMS will accept comments on the proposed rule until September 10, 2018, and will respond to comments in a final rule. The proposed rule can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection.

CY 2018 Physician Fee Schedule Final Rule

The CY 2018 Medicare Physician Fee Schedule Final Rule  was placed on display at the Federal Register on November 2, 2017. This final rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2018.

In addition to policies affecting the calculation of payment rates, this final rule identifies potentially misvalued codes, adds procedures to the telehealth list, and finalizes a number of new policies.

CY 2018 Physician Fee Schedule Proposed Rule with Comment Period

The  CY 2018 Medicare Physician Fee Schedule Proposed Rule with comment period  was placed on display at the Federal Register on July 13, 2017. This proposed rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2018.

In addition to policies affecting the calculation of payment rates, this proposed rule proposes potentially misvalued codes, adding procedures to the telehealth list, and a number of new policies. CMS will accept comments on the proposed rule until September 11, 2017, and will respond to comments in a final rule. The proposed rule can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection.

Care Management

For a one-stop resource focused on new Care Management services under the Physician Fee Schedule, such as chronic care management and transitional care management services, visit the Care Management webpage. 

Physician Center

For a one-stop resource focused on Medicare Fee-for-Service (FFS) physicians, visit the Physician Center webpage.

Page Last Modified:
11/01/2019 04:20 PM