News & Press: Advocacy

SIS Reviewing and Commenting on Proposed Medicare Physician Fee Schedule Rule

Tuesday, July 17, 2018  
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In the proposed rule released last week, the Centers for Medicare and Medicaid Services (CMS) has put forward several changes that will affect SIS members:
  • Collapse of payment for physician new and established patient office and outpatient visits into a single payment regardless of visit level (e.g., the same payment for a level 2 established patient visit-CPT code 99212, as a level 5 established patient visit-CPT code 99215)
  • Replacement of existing documentation guidelines with requirement to only document medical decision-making, review of patient history since last visit, or time spent face-to-face with patient
  • New add-on payments for additional E/M time greater than 60 minutes
  • Reduction in payments when E/M services and procedures are reported on the same date
  • Proposed values for neurostimulator programming codes
If finalized, these changes will go into effect for the 2019 Medicare Physician Fee Schedule.

CMS is also requesting comments on potential elimination of the 10-day global period, which would reduce the reimbursement values for all codes with 10-day globals. CMS is not proposing elimination of the 10-day global period for calendar year 2019, but potentially considering the action for future years.
SIS is currently reviewing the rule and will be commenting to CMS on the above issues and more to promote appropriate reimbursement for interventional spine procedures.

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