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CMS Medicare physician fee schedule for 2015 Final Rule released

The Physician Fee Schedule Final Rule was published November 13, 2014. It provides not only new payment rates but also changes to Medicare payment policies. Here is a summary of some changes that could affect your medical office.
Telehealth services. Specific telehealth services must be included in the list of Medicare telehealth services and meet other conditions for Medicare payment to be made. For 2015, CMS has added services to the telehealth list, including services represented by the following CPT® codes:

  • Psychotherapy codes: CPT® Codes 90845 (psychoanalysis), 90846 (family psychotherapy-patient not present), and 90847 (family psychotherapy-patient present).
  • Prolonged service codes: CPT® Codes 99354 and 99355 for prolonged services in the office or other outpatient setting requiring direct patient contact beyond usual service (first hour and additional 30 minutes).
  • Wellness services: HCPCS Codes G0438 and G0439 for annual wellness visits.

CMS also adjusted the originating site facility fee payment amount for 2015, increasing payment for HCPCS code Q3014 to 80% of the lesser of the actual charge or $24.83.

Chronic Care Management. CMS indicated that effective January 1, 2015, it will accept new CPT® Code 99490 to describe chronic care management (CCM) services in place of the G-code it had been requiring. Additionally, rather than 30 days as the service period it will accept the calendar month as the service period. CMS also revised its “incident to” rules to permit CCM and transitional care management services be “provided by clinical staff incident to the services of a practitioner to be furnished under the general supervision of a physician or other practitioner.” The supervising physician need not be the same physician whose professional service the billed service is incident to. CMS explained this change by stating that consultation with physicians and others led CMS to conclude that “for purposes of clinical staff providing aspects of CCM services, it does not matter whether the practitioner is directly available to supervise because the nature of the services are such that they can be, and frequently are, provided outside the normal business hours or while the physician is away from the office during normal business hours.” It said that unlike other incident-to services, these chronic care management services “are intrinsically non-face-to-face care coordination services.” Finally, CMS is requiring that practitioners “must at least electronically capture care plan information” and make it available 24/7 to all practitioners in a practice who provide CCM services whose time counts toward the time requirement for billing the CCM code and share care plan information electronically with others providing care to the patient. CMS doesn’t specify the method but says the method must be electronic and can’t include fax.

Colorectal cancer screenings. CMS revised the definition of colorectal cancer screening test to include anesthesia furnished “in conjunction with screening colonoscopies.”
Open Payments disclosures. CMS made some changes to the Open Payments (aka Sunshine Law) regulatory requirements in response to feedback. The Open Payments law requires manufacturers report to CMS certain payments made to physicians and physician ownership interests in manufacturers. Here are some of the reporting requirements CMS addressed in the fee schedule:

  • Continuing education speakers. To avoid any inconsistency with regard to reporting payments to physician speakers at continuing education events, CMS is removing Section 403.904(g) in its entirety. That section excludes from reporting obligations payments to speakers at continuing education events that meet certain criteria, including that it must meet accreditation or certification requirements and standards of one of several accrediting bodies named in the regulations. Other accreditation entities have sought to be added to that list of named entities. CMS noted that its intent wasn’t to appear to be endorsing or supporting any of the named accreditation/certification entities. Additionally, commenters indicated to CMS that the section led to inconsistency in reporting with regard to continuing education speakers. So it deleted the section. Payments to continuing education speakers will continue to be excluded if they are made indirectly—which means the manufacturer doesn’t know the identity of the speaker and doesn’t control the selection of the speaker but rather pays the sponsor who has discretion to coordinate the continuing education program and choose the speakers. This exclusion is covered by the preexisting language in another section 403.904(i)(1). Commenters expressed concern that the indirect payments exclusion requires the manufacturer not know the identity of the covered recipient during the reporting year or until the end of the second quarter in the next reporting year. They said such speakers will be discoverable to the manufacturer through event brochures and other publicly available material about the event. CMS responded that such payments in those cases aren’t indirect. However, such payments for CME events would still not be required to be reported, CMS explains, because it’s not an indirect payment as defined in 403.902 and it’s an unrestricted donation to a physician organization to use at the organization’s discretion. That means it’s not a payment, direct or indirect, to a physician and isn’t reportable as a payment to a physician. Payments by a manufacturer directly to a speaker at such a continuing education event or which are paid to the conference coordinator but directed by the manufacturer or conditioned on payment to a specific identified speaker will be required to be reported.
  • Marketed name of item. CMS also eliminated an inconsistency with regard to reporting the marketed name of an item. Existing rules required reporting of the marketed name under 403.904(c)(8) for all covered drugs and biologicals relating to a payment to a physician. But for devices and medical supplies manufacturers had the option to report the marketed name, product category or therapeutic area for the device or medical supply. That difference in reporting had resulted because the marketed name might not be useful to general audiences. Now, however, CMS is revising 403.904(c)(8) to require reporting of the marketed name for all covered drugs, devices, biologicals or medical supplies so there is consistent reporting in data fields and use of data. Manufacturers can opt to additionally report the product category or therapeutic area for devices and supplies. This change goes into effect in January 2016 because CMS recognizes it requires changes to data collection and reporting systems.
  • Stocks, options, ownership. Finally, CMS decided that reporting stock, stock options or other ownership interests should be made in distinct categories rather than one aggregate category.

CEHRT. Medical offices will get some minor relief with regard to CEHRT. CMS has decided that beginning in 2014, eligible professionals (not eligible hospitals or critical access hospitals) won’t have to ensure that their CEHRT products are recertified to the most recent version of the electronic specifications for the CQMs. But eligible professionals must still report the most recent version of electronic specifications for CQMs.

CPT® five-digit codes, descriptions, and other data only are copyright 2014 by the American Medical Association (AMA). All Rights Reserved. CPT® is a registered trademark of the American Medical Association (AMA).









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