Update on Medicare Physician Fee Schedule

Members & Publications

December 16, 2016

On November 15, 2016, the Centers for Medicare & Medicaid Services (CMS) released its Medicare Physician Fee Schedule final rule. The rule finalizes Medicare payment and policies for services effective January 1, 2017. CMS made a number of changes to the proposed policies based on feedback AAPM&R submitted in September. Notably, CMS elected not to require a resurvey of a number of codes billed by physiatrists including trigger point injections, arthrocentesis, and osteopathic manipulations. CMS continues to expand payment for primary care services including a number of services physiatrists provide. A new code, G0505 was established in the rule to reimburse for assessment and care planning for patients with cognitive impairments. Finally, CMS elected not to assign reimbursement to its new add-on code for services provided to patients with mobility-related disabilities. The code is considered bundled for 2017 and CMS is not requiring providers to bill it. AAPM&R supports the concept of more fairly reimbursing for the additional work and practice expense of treating patients with disabilities, but we objected to CMS’ proposal because it would impose a higher payment on the part of patients with disabilities. 

Your Academy will continue to work with CMS on this and other issues related to physician payment throughout 2017. A more detailed report of the Medicare Physician Fee Schedule will be included in the February issue of The Physiatrist

Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.