Late Thursday, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2019 Medicare Physician Fee Schedule (PFS) proposed rule, which includes several significant policy and payment changes that will impact gastroenterologists. This year, the PFS proposed rule also includes changes to year three of the Quality Payment Program (QPP).
This communication offers a topline summary of the most important proposed changes to the payment rates and policies for services paid under the Medicare PFS. The PFS proposed rule will appear in the
on July 17
and can be downloaded
- Major evaluation and management (E/M) changes aimed at reducing physician burden impact coding and reimbursement.
- EGD and colonoscopy codes identified by an outside party as potentially misvalued.
- Weight of the cost performance category under QPP increases from 10% to 15%.
- CMS proposes adding a GI-specific cost measure for screening/surveillance colonoscopy.
- QPP performance threshold increases from 15 points to 30 points.
ACG, AGA and ASGE are currently reviewing the details of the proposed rules and will be providing joint comments.
CMS will accept comments until September 10, 2018, and will respond to comments in a final rule to be issued on or around November 1, 2018. We will keep you updated as we learn more.
Medicare Physician Payment
- 2019 Proposed Conversion Factor: The proposed 2019 PFS conversion factor is $36.05, an increase of .03 percent from the 2018 PFS conversion factor of $35.99. Click here to review 2019 MPFS proposed Relative Value Units (RVUs) for GI services.
- Reforming Evaluation and Management (E/M) Payment: CMS proposes a major new reimbursement methodology for E/M services effective January 1, 2019. Under the proposal, new patient level 2-5 (99202-99205) and established patient level 2-5 (99212-99215) services would receive one blended payment.
The table below reflects the proposed rates.