2019 Medicare Physician Fee Schedule and Quality Payment Program Proposed Rule
The Centers for Medicare & Medicaid Services (CMS) issued the 2019 Medicare Physician Fee Schedule and Quality Payment Program proposed rule on July 25, 2018. The proposed rule highlights potential revisions to policies and payment rates for services provided and billed during the 2019 calendar year. AASM submitted a comment letter, in response, highlighting revisions that may be most impactful for both individual and facility members. View the rule, the AASM response, and other resources:
- Proposed Rule
- Physician Fee Schedule Proposed Rule Fact Sheet
- Quality Payment Program Proposed Rule Fact Sheet
- AASM Response to the Proposed Rule
- American Medical Association Response to the Proposed Rule
2018 Medicare Physician Fee Schedule Final Rule
On November 15, 2017, the Centers for Medicare & Medicaid Services (CMS) issued the 2018 Medicare Physician Fee Schedule final rule, which provides updates to payment policies and payment rates for services billed on or after Jan. 1, 2018. Download these supplemental resources for more information about the final rule:
- Final Rule Summary
- Sleep Medicine Payment and RVU Comparison
- Evaluation and Management Payment and RVU Comparison
Members with additional questions about the final rule can submit them via email to email@example.com.
Performing a Medicare Physician Fee Schedule Search
Go to the Centers for Medicare & Medicaid Services (CMS) website to search the Medicare Physician Fee Schedule (MPFS). The MPFS search page is an easily accessible way to find payment information for services. Payment can be searched by locality to find the variation in reimbursement from region to region. Additionally, searches can be performed with or without modifiers to help determine the exact reimbursement for a service performed.
From the overview page, click Start Search. You will be taken to a page with terms and agreements. Select Agree to be redirected to the search page.
- Field: Select a year. You can select this year (2017) to determine reimbursement for current services or search previous years.
- Field: Type of information. Click the buttons to indicate the type of information you are looking for. This can include pricing information, payment policy indicators, relative value units or geographic practice cost index. You can also select all. For reimbursement information, select the pricing information option.
- Field: Select the Healthcare Common Procedure Coding System (HCPCS) Criteria. This section allows you to search by a single code or select a list or range of codes. The specific codes are entered in a later step, but changing your selection at this step will provide you with the correct fields to enter your search later.
- Field: Select Carrier/Medicare Administrative Contractor (MAC) Option. This allows you to specify if you want to search by national payment amount, specific carrier/MAC, specific locality or all carriers/MACs. Just as with step three, this detailed information required for your specific search will be entered later, but changing your selection at this step will provide you with the correct fields to enter your search later.
- Field: HCPCS Code. Depending on what you selected for #3 above, you will enter a single HCPCS code, a list of codes, or a range of codes at this step. For example, if you would like to search payment for all sleep medicine testing codes, you could select “Range of HCPCS Codes” at step #3 and enter “95800-95811” at this step.
- Field: Modifier. Select the modifier for the code you are searching. If you would like to search without a modifier, select the “Global” option. Modifiers TC and 26 will allow you to find reimbursement for the technical component and professional component (respectively) of a given service.
- Field: Carrier/MAC or Locality. Depending on what option you selected for #4 above, you may be asked to select your Carrier/MAC or indicate your locality. You do have the option of selecting “national.”
Click “SUBMIT” to receive the results of your search. Your results will appear in the form of a spreadsheet with a number of columns. If you have searched a number of different codes, each code will be listed on a separate row.
Performing a Medicare Policy Search
Go to the CMS Centers for Medicare & Medicaid Services website to search the Medicare Coverage Database. The Medicare Coverage Database includes documents such as articles and policies related to all Medicare programs including but not limited to Part B coverage and DME. Using the advanced search feature described below, you can search policy and article information by contractor and/or state.
To search by Document ID, enter the ID and click “SEARCH BY ID”
Select the coverage you would like to search – for example, “local coverage.”
Choose the geographic area you would like to search (you can search all states, or your specific area).
Enter your keyword (aka “sleep”) and/or the CPT/HCPCS code you would like to search (aka “95810”).
Click “search by type” to be taken to a page with your search results.
- Often “sleep” is a better term to use than something too specific.
- Spell out acronyms such as Independent Diagnostic Testing Facility. If you use IDTF as your search term, you may not get any hits. Using Independent Diagnostic Testing Facility provides several hits.
Above the “SEARCH BY TYPE” button, click the link “Need more search power? Try Advanced Search” to get to the Advanced Search Feature. You may want to use this feature if your basic search did not produce the desired results.
The advanced search option includes the following steps:
Step 1 – Select the document type you want to search. By selecting national coverage or local coverage you are given the option to search for different types of documents. For local coverage, policies and articles are available. The national coverage option includes additional document types such as analyses, decisions, and technology assessments. National coverage decisions and local coverage policies and articles will be most helpful to you for a typical search. You can also choose to search both national and local coverage.
Step 2 (Local Coverage) – This step only appears when you click to search local coverage or both national and local coverage. Use this feature to help locate information on your geographic area and/or contractor. There is also a link to completed A/B Medicare Administrative Contractor (MAC) transitions as well as links to view county listings and region descriptions.
Note: If you are in a state where a new MAC has been announced, do not assume that on the date the announcement was made you automatically begin using the new contractor’s policies. The transition period from one contractor to another may take months. Use this web site to see what policy is now in force in your state and look for announcements on the new Contractor’s website/newsletters indicating when the policies will change for your state.
Step 3 (Local Coverage) / Step 2 (National Coverage) – Optional search criteria. Use this option if you intend to search by code number, range of codes or by date. Note: when specifying multiple criteria, only records meeting all criteria are returned.
Once you have completed all necessary fields of the advanced search feature, click “SEARCH BY TYPE” to produce your results.
The CMS Centers for Medicare & Medicaid Services website features a basket tool, which appears as an image of a basket at the top of the search page. Use this to tool to save documents as you review your results. The basket tool is particularly useful if you perform multiple searches.