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Physician Fee Schedule

CY 2017 Physician Fee Schedule Proposed Rule with Comment Period

The CY 2017 Medicare Physician Fee Schedule Proposed Rule with comment period was placed on display at the Federal Register on July 7, 2016. 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, 2017.

The calendar year 2017 PFS proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a health care system that results in better care, smarter spending, and healthier people.

CY 2016 Physician Fee Schedule Final Rule with Comment Period

The CY 2016 Medicare Physician Fee Schedule Final Rule with comment period was placed on display at the Federal Register on October 30, 2015.  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, including several that are a result of recently enacted legislation. The rule also finalizes changes to several of the quality reporting initiatives that are associated with PFS payments, including the Physician Quality Reporting System (PQRS), the Physician Value-Based Payment Modifier (Value Modifier), and the Medicare Electronic Health Record (EHR) Incentive Program, as well as changes to the Physician Compare website on Medicare.gov.  This is the first PFS final rule since the repeal of the Sustainable Growth Rate (SGR) formula by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  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.

CY 2016 Physician Fee Schedule Proposed Rule with Comment Period

The CY 2016 Medicare Physician Fee Schedule Proposed Rule with comment period was placed on display at the Federal Register on July 08, 2015. In this major proposed rule, we propose RVUs for CY 2016 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, and a number of new policies, including several that are a result of recently enacted legislation. The rule also proposes changes to several of the quality reporting initiatives that are associated with PFS payments, including the Physician Quality Reporting System (PQRS), the Physician Value-Based Payment Modifier (Value Modifier), and the Medicare Electronic Health Record (EHR) Incentive Program, as well as changes to the Physician Compare website on Medicare.gov.  This is the first PFS proposed rule since the repeal of the Sustainable Growth Rate (SGR) formula by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  Through the proposed rule, CMS is beginning implementation of the new payment system for physicians and other practitioners, the Merit-Based Incentive Payment System (MIPS), required by the legislation.  The calendar year 2016 PFS proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a health care system that results in better care, smarter spending, and healthier people.

Revised Transitional Care Management Services Fact Sheet and FAQs on Billing Transitional Care Management Services

See the Downloads Section for the revised Transitional Care Management Services Fact Sheet and several updates to the FAQs regarding payment for Transitional Care Management (TCM) services. We are updating our subregulatory guidance to reflect several changes to TCM payment policy in the CY 2013, CY 2015 and CY 2016 Medicare Physician Fee Schedule final rules regarding claims submission, timeframe for the interactive contact, the application of incident to rules and other policies.

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).