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CMS Releases 2019 Medicare Physician Fee Schedule Finalized Rule

posted: December 11, 2018

Included in the proposed changes were plans to collapse evaluation and management codes (E/M) levels 2-5 under a single payment rate. CMS argued a single blended payment rate would reduce administrative burden, with the affected E/M code types subject to reduced documentation standards.

Many physicians, particularly specialty physicians who treat complex cases, have been extremely concerned that the new blended payment rate would represent unsustainable cuts to reimbursements. The OAR urged members to submit their own comments in opposition of the proposed rule, and provided draft sample comments to use. CMS received over 15,000 comments on the proposed rule, with the majority opposing the rule.

On November 1, 2018, CMS released its finalized rule, which slightly modified the code blending proposal. While CMS still intends to collapse levels 2-4 under a single payment rate, level 5 E/M visits will not be included in the bended code and will remain distinct. Implementation of the rule was also postponed to 2021. The OAR will continue to monitor the rule’s status and advocate against unfair reimbursement reduction.

Reimbursement rates under the newly modified proposal can be found in the CMS payment chart.