2017 Medicare Physician Fee Schedule Proposed Rule Released; ASCRS and Ophthalmic Community Advocacy Prompts CMS to Reconsider Glaucoma and Retina Cuts

2017 MEDICARE PHYSICIAN FEE SCHEDULE (MPFS)
PROPOSED RULE RELEASED

ASCRS and Ophthalmic Community Advocacy Results in Restoration of RUC-Recommend Values for Glaucoma and Retina Procedures

Proposed 2017 Conversion Factor $35.7751

Late this afternoon, CMS released the CY 2017 MPFS Proposed Rule, which will be published in the Federal Register on July 15, 2016. There is a 60 day comment period for this proposed rule. ASCRS will be submitting comments.

2017 MPFS Conversion Factor 

The CY 2017 proposed MPFS conversion factor is $35.7751, which reflects a budget neutrality adjustment of -0.51% and the 0.5% update factor specified under MACRA.

Reconsideration of Cuts to Glaucoma and Retina Procedures

Following extensive advocacy from ASCRS and the ophthalmic community, CMS is proposing to reconsider cuts to certain Glaucoma and Retina procedures finalized under the CY 2016 MPFS. For CY 2017, CMS proposes to accept the original RUC-recommended RVUs for several glaucoma and retina procedures. 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 proposes to retain the original RUC-recommended RVUs for the following codes:

  • 65855 (trabeculoplasty)
  • 66170 (trabeculectomy)
  • 66172 (trabeculectomy with scarring)
  • 67107 (retinal detachment with scleral buckle)
  • 67108 (retinal detachment with vitrectomy)
  • 67110 (retinal detachment by injection)

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

CMS notes 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. 

Improving the Valuation and Coding of the Global Package

For CY 2017, CMS is proposing to collect data on the valuation of 10- and 90-day global surgical codes. CMS proposes to require all physicians providing services with a 10- or 90-day global period to report pre- and post-operative services furnished on claims. In addition, CMS will conduct a survey of 5,000 practitioners to gather additional data. In CY 2015, CMS finalized a proposal to transition all 10- and 90-day global surgical codes to 0-day. However, surgical community advocacy prompted Congress to prohibit CMS from proceeding with the policy in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA required CMS to collect data on the value of global surgical codes but did not require all physicians to participate in data collection. ASCRS will be commenting on the proposed rule and will join with the surgical community to oppose this onerous data collection requirement.

Focus on Improving the Value of Primary Care Services

In the proposed rule, CMS places a significant focus on improving the value of primary care services. CMS proposes to increase reimbursement for certain codes and make separate payments for new codes for primary care services. In addition, the proposed rule makes several proposals related to chronic care management. ASCRS is concerned the proposed 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.

Nonfacility Cataract Surgery

CMS did not include any proposals related to office-based surgical suite cataract surgery in this proposed rule.

Medicare Advantage Provider and Supplier Enrollment

For CY 2017, CMS proposes to require healthcare providers and supplies 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 Proposed Rule on CY 2016 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.