CMS Releases 2015 Final Rule on Physician Fee Schedule
Monday, December 8, 2014
Posted by: Becky Dryden
On October 31, 2014 the Centers for Medicare and
Medicaid Services (CMS) released its final rule for the CY 2015 Medicare
Physician Fee Schedule, finalizing the rule for 2015 implementation. CMS will
move forward with eliminating the 10- and 90-day global surgery codes and has
slightly reduced the reimbursement for the new chronic care management code.
Global Surgery Codes
moved forward with eliminating 10- and 90-day global surgery codes, but will do
so in a staged manner. The elimination will begin with the 10-day global
services in 2017 and followed by 90-day global services in 2018. These codes
include the patient visit on the day of the procedure, the procedure itself, and
any complications resulting from the surgery, and all follow-up care during the
10- or 90-day recovery period.
found that global codes may pay for more follow-up care than is usually
furnished to Medicare patients resulting in the 2015 final rule timeline for
eliminating 10- and 90-day global payments for all care settings. This will
require physicians to bill separately for the day of the surgery (known as a
zero-day global payment) and any encounters after that day.
rule set reimbursement for the new chronic care management code at $41.92, but
CMS has set the finalized amount at a lower amount of $40.39. Providers are
able to bill the new code once per patient every 30 days, if they provide at
least 20 minutes of care coordination work during that period. This includes
non-face-to-face coordination services such as revision of patient care plans,
medication management, and communication among treating practitioners.
CMS has also
finalized two key proposals tied to the implementation of this code:
team-based care: The
final rule allows physicians to provide only general supervision rather than
direct on-site oversight to clinical staff members whose activities can count
toward the required 20 minutes of work.
in use of Electronic Health Records (EHRs):
EHRs do not have to be 2014-certified as initially proposed. CMS will allow practitioners to bill for services provided under the new
chronic care management codes from a 2013-certified EHR system if they have not
upgraded to a 2014-certified system.