Below is a look at some of the key changes that the Centers for Medicare & Medicaid Services (CMS) issued in its final rule on October 31, 2014. These changes will become effective January 1, 2015. This summary is informed by CMS’ 10/31/2014 published “Fact Sheet: Policy and payment changes to the Medicare Physician Fee Schedule 2015.”
Sustainable Growth Rate (SGR)
The proposed 21.2 SGR cut that looms over physicians every year is not in question for the first 3 months of 2015 (legislation passed in 2014 protected the fee schedule through March 31, 2015). The SGR cut will need to be re-evaluated by Congress for April 1, 2015 forward.
Screening and diagnostic digital mammography
Until now, there have not been separate codes to pay for the higher cost of 3D mammography as compared to 2D mammography. CMS will now be paying for 3D mammography using add-on codes that will be reported in addition to the 2D mammography codes.
Primary care: new chronic care management code
Effective Jan 1, 2015, Medicare is implementing payment for chronic care management (CCM) services – non-face-to-face services to Medicare beneficiaries who have multiple, significant, chronic conditions (two or more). Chronic care management services include regular development and revision of a plan of care, communication with other treating health professionals, and medication management.
CMS has established a payment rate of $40.39 for CCM that can be billed up to once per month per qualified patient. The CPT that will be billed for CCM is 99490. Providers must meet certain requirements in order to bill this code, including a written patient consent form, and the provider’s use of certified EHR technology.
No beneficiary cost sharing for anesthesia related to screening colonoscopies
The existing Medicare statute waives the Part B deductible and coinsurance applicable to screening colonoscopy. In the CY 2015 final rule, by revising the definition of a “screening colonoscopy,” CMS is including separately provided anesthesia as part of the screening service so that the coinsurance and deductible do not apply to anesthesia for a screening colonoscopy, reducing beneficiaries’ cost-sharing obligations under Part B.
Potentially misvalued services: Hip & Knee Replacements (No change)
In the CY 2014 PFS final rule, CMS adopted code and valuation changes that reduced payment for hip and knee replacements. CMS initially suggested that it would consider further reductions for 2015; however, the final rule indicates that no further cuts will be made to these payments.
Access to telehealth services
CMS is adding the following services to the list of services that can be furnished to Medicare beneficiaries under the telehealth benefit: annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management services.
The CMS Fact Sheet: Policy and payment changes to the Medicare Physician Fee Schedule for 2015 can be viewed here: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-10-31-7.html.