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Value Modifier (VM or PVBM)


The Value Modifier (VM) Program

What's the Value Modifier (also called the Physician Value-Based Modifier) Program?

The Value Modifier Program measures the quality and cost of care provided to people with Medicare under the Medicare Physician Fee Schedule (PFS).

The Value Modifier is an adjustment made on a per claim basis to Medicare payments for items and services under the Medicare PFS. It’s applied at the Taxpayer Identification Number (TIN) level to doctors billing under the TIN.

Why's the Value Modifier Program important?

The Value Modifier Program determines the amount of Medicare payments to physicians based on their performance on specified quality and cost measures. The program rewards quality performance and lower costs.

Who’s included in the Value Modifier Program?

We’re phasing in the Value Modifier Program:

  • In 2015, payment adjustments will apply to physicians in groups of 100 or more eligible professionals (EPs) based on their performance in 2013.
  • In 2016, the payment adjustments will apply to physicians in groups of 10 or more EPs based on their performance in 2014.
  • In 2017, payment adjustments will apply to physician solo practitioners and physicians in groups of 2 or more EPs based on their performance in 2015.
  • In 2018, in addition to all physicians, we proposed to apply payment adjustments  to physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists who are solo practitioners or in groups of 2 or more EPs based on their performance in 2016.

The final policies for the 2018 Value Modifier will be published in the 2016 Medicare Physician Fee Schedule final rule.


You can also learn more about the Value Modifier Program from these resources:

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