CMS Releases Proposed CY 2017 Physician Fee Schedule

The Center for Medicare and Medicaid Services (CMS) recently released proposed Medicare Physician Fee Schedule (PFS) for CY 2017. Comments on the proposed schedule are due by 5:00 PM EST on September 6, 2016.

Included in the proposal, is the addition of several codes for reimbursement regarding end-state renal disease related services for dialysis; advance care planning; and critical care consultations via telehealth using new Medicare G-codes. In addition, CMS is proposing a new payment policy related to the use of a new place of service (POS) code specifically designated to report services completed using telehealth.

For CY 2017, CMS proposes adding the following codes:

  • End-stage renal disease (ESRD) codes 90967, 90968, 90969, and 90970 stating that the codes are sufficiently similar to ESRD-related services currently on the telehealth list to qualify on a category 1 basis. The proposed fee schedule notes that there is a required clinical examination of the catheter access site which must be furnished face-to-face “hands on”.
  • Advance care planning codes 99497 and 99498, determining that they are similar to annual wellness visit codes already on the telehealth list.

On top of these, CMS is proposing the creation of new codes to reflect the resource cost of providing critical care consultation services remotely for critically ill patients. CMS is proposing new codes (GTTT1 and GTTT2) for initial and follow-up services, used to specifically describe critical care consultations furnished via telehealth. CMS proposes to require physicians or practitioners furnishing telehealth services to report the telehealth Place of Service (POS) to indicate that the billed service is furnished via telehealth from a distant site.

For more information on the proposed schedule by CMS, click here.


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