Medicare Releases 2016 Physician Fee Schedule

Date: January 14, 2016

Earlier this week, the Centers for Medicare & Medicaid (CMS), released the 2016 Medicare Physician Fee Schedule (MPFS).  You can link to the CMS file here.  The draft version of the MPFS released late in the Fall was noted by CMS to require some revisions.  All Medicare Administrative Contractors (MAC) had previously announced on their websites that they were instructed to place a hold on processing 2016 date of service claims until January 14, 2016.  Importantly, claims with 2015 dates of service were not affected by the processing delay.  With the release of the 2016 MPFS, we expect normal claims processing to begin late this week; claims will be processed in the order received so some small delays of a few days might occur.  It may take the MACs a few days to post the appropriate fee schedules for their locales.  As of this writing, for example, Palmetto GBA had not made the MPFS files available but First Coast Service Options (FCSO) does have them posted and ready for download.

The 2016 MPFS contains a few important changes from the draft version posted earlier; these changes were expected:

  • The global period for CPT codes 67227 and 67228 is changed to 10 days from the previous 90 days; they are both therefore now “minor procedures”.
  • CPT 66984 had the practice expense portion of the code revised; the total RVUs are now slightly higher at 18.11 than previously published.  Although there is still a reduction of 1% from 2015 levels, it is less than the original proposal.
  • The Conversion Factor (CF) decreased a few cents to $35.8043.
  • Geographic Indices were corrected.

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