CMS Finalizes Policies that Reduce Provider Burden, Lower Drug Prices

November 6, 2017

On Thursday, November 2, the Centers for Medicare & Medicaid Services (CMS) issued a final rule for the 2018 Physician Fee Schedule and final rule with comment period for the Quality Payment Program (QPP). While part of CMS’s broader strategy to relieve regulatory burdens for providers, these rules also reflect the agency’s efforts to promote innovation in healthcare delivery aimed at lowering prices, increasing competition and strengthening the relationship between patients and their doctors.

CMS listened to feedback from the health care community, including your Academy, and used it to inform policy making. Your Academy is diligently reviewing the new rule, and we will share more information soon.  In the meantime, below are some key “wins” for physiatry:

• CMS approved a significant increase to payment for codes 64553 and 64555 for percutaneous implantation of neurostimulator electrode array.  In 2018 these services will be reimbursed at more than double their 2017 reimbursement rate. 
• CMS approved a phase-in of the reimbursement cut to code 76881 for complete ultrasound of extremity.  The cut to reimbursement for this service will therefore be significantly less than initially proposed for 2018.
• Beginning in 2018, PM&R physicians who provide remote monitoring services including collection and interpretation of physiologic data requiring a minimum of 30 minutes of time can receive separate payment for this service under code 99091.
• Based on public comment, including those submitted by your Academy, CMS has agreed to consider collaborative approaches to revising the guidelines for evaluation and management services.

More Information

• The Physician Fee Schedule final rule (CMS-1676-F) can be downloaded from the Federal Register at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-23953.pdf.
• For a fact sheet on the Physician Fee Schedule final rule, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-11-02.html.
• The Quality Payment Program final rule with comment period (CMS-5522-FC and CMS-5522-IFC) can be downloaded from the Federal Register at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-24067.pdf.
• For a fact sheet on the Quality Payment Program final rule with comment period, please visit: https://www.cms.gov/Medicare/Quality-Payment-Program/resource-library/QPP-Year-2-Final-Rule-Fact-Sheet.pdf