2017 Medicare Physician Fee Schedule (MPFS) Final Rule Released

ASCRS Advocacy Results in Modification to the Onerous Global Surgery Data Collection Policy and Restoration of RUC-Recommend Values for  Glaucoma and Retina Procedures

2017 Conversion Factor $35.8887

Late yesterday afternoon, CMS released the CY 2017 MPFS Final Rule, which will be published in the Federal Register on November 15, 2016. 

2017 MPFS Conversion Factor 

The CY 2017 MPFS conversion factor is $35.8887, which reflects a budget neutrality adjustment of -0.013%, a misvalued code reduction target adjustment of -0.18%, and the positive 0.5% update factor specified under MACRA.

Modifications to Global Data Surgery Collection Policy

Following extensive advocacy by ASCRS and the surgical community, for CY 2017, CMS is modifying its proposal to collect data on the valuation of 10- and 90-day global surgical codes. CMS will not require all physicians providing services with a 10- or 90-day global period to report post-operative services furnished in 10-minute increments on claims beginning January 1, 2017. Instead, CMS is finalizing a modified policy to require:

  • Only practitioners who practice in groups with 10 or more practitioners in certain states are required to report. The affected states are:
    • Florida,
    • Kentucky,
    • Louisiana,
    • Nevada,
    • New Jersey,
    • North Dakota,
    • Ohio,
    • Oregon, and 
    • Rhode Island.
  • Reporting only on services related to codes reported annually by more than 100 practitioners and that are reported more than 10,000 times or have allowed charges in excess of $10 million annually
  • Coding of CPT code 99024 to report post-operative services included in the global package, rather than the proposed set of G-codes.
  • Mandatory reporting will not begin until July 1, 2017, but physicians can opt to report beginning January 1, 2017. 

CMS also finalized its proposal to conduct a survey of 5,000 practitioners to gather additional data. 

Reconsideration of Cuts to Glaucoma and Retina Procedures

Following advocacy from ASCRS and the ophthalmic community, CMS is finalizing new values to certain Glaucoma and Retina procedures finalized under the CY 2016 MPFS. For CY 2017, CMS will value several glaucoma and retina procedure codes at the original RUC-recommended RVUs. ASCRS and the ophthalmic community argued that when CMS revalued these codes for 2016 as part of the misvalued codes initiative, the agency solely took time into account and did not consider intensity, as required by law. 

Specifically, CMS will retain the original RUC-recommended RVUs for the following codes:

Thank you to all ASCRS and ASOA members who contacted their members of Congress in support of our advocacy on this issue. Your efforts made a difference!

Potentially Misvalued Codes

In the proposed rule CMS estimated the potentially misvalued codes targeted for revaluation in this proposed rule would satisfy the target required by statute, and thus would not trigger across-the-board cuts to all codes. However, in the final rule, CMS' determined the misvalued code target for 2017 of 0.5% would not be met, and would only be 0.32%, resulting in an -0.18% adjustment to the conversion factor.

Focus on Improving the Value of Primary Care Services

In the final rule, CMS places a significant focus on improving the value of primary care services. CMS will increase reimbursement for certain codes and make separate payments for new codes for primary care services. In addition, CMS finalized several proposals related to chronic care management. ASCRS is concerned the final rule continues to prioritize primary care services over specialty care and will continue to advocate that CMS not reduce reimbursement for specialty services to off-set increases for primary care services.

Medicare Advantage Provider and Supplier Enrollment

For CY 2017, CMS finalized requiring healthcare providers and suppliers to be screened and enrolled in Medicare in order to contract with a Medicare Advantage organization to provide Medicare-covered items and services to beneficiaries enrolled in Medicare Advantage plans.

Impact of Final Rule on CY 2017 Payment for Selected Procedures

Additional information will be detailed in upcoming editions of Washington Watch Weekly. For questions, please contact Allison Madson, manager of regulatory affairs, at 703-591-2220 or amadson@ascrs.org.