The Centers for Medicare and Medicaid Services (CMS) issued a final rule that updates payment policies and rates for the Medicare Physician Fee Schedule (MPFS) in calendar year 2012. Unless Congress intervenes with the current law, Medicare payment rates to providers paid under the MPFS will be reduced by 27.4% for services delivered on or after January 1, 2012.

In addition to the MPFS reduction, some other major changes are being adopted in the final rule:

• Imaging: Reduction for multiple interpretations for the same patient on the same day.
• Annual Wellness Visit: Adopting criteria for a health risk assessment (HRA) to be used in conjunction with Annual Wellness Visits.
• Telehealth: CMS is expanding the list of services that can be furnished through telehealth to include smoking cessation.
• Incentive Programs: Modifying aspects of PQRS, e-RX, and EHR incentive program.
• New Modifier: Establishing a new value-based modifier that would adjust physician payments based on whether they are providing higher quality and more efficient care. The rule finalizes 2013 as the initial performance year for purposes of adjusting payments in 2015.

We will be following this issue closely as we recognize that the fee schedule reduction will have a significant impact on providers.  

We have provided a link below to the final rule so you can read this in detail.  We have also provided some state links that will take you to the 2011 and 2012 MPFS so you can do a comparison of the reimbursement rates.

Final Rule:  http://www.ofr.gov/(X(1)S(rslbjdzibq5hbqjugnbodt5l))/OFRUpload/OFRData/2011-28597_PI.pdf

Colorado

2011 Fee Schedule:  http://www.trailblazerhealth.com/Tools/Fee%20Schedule/Downloads/Medicare/FS29CO11.pdf

2012 Fee Schedule:  http://www.trailblazerhealth.com/Tools/Fee%20Schedule/Downloads/Medicare/FS29CO12.pdf

Nebraska

2011 Fee Schedule:  http://wpsmedicare.com/j5macpartb/fees/physician_fee_schedule/_files/2011_ne.pdf

2012 Fee Schedule:  http://wpsmedicare.com/j5macpartb/fees/physician_fee_schedule/_files/12_ne.pdf

Los Angeles County

2011 Fee Schedule:  http://www.palmettogba.com/Palmetto/Providers.Nsf/files/2011_SCAL_18_Rev_MPFS.xls/$File/2011_SCAL_18_Rev_MPFS.xls

2012 Fee Schedule: http://www.palmettogba.com/Palmetto/Providers.Nsf/files/2012_SCAL_18_MPFS.xls/$File/2012_SCAL_18_MPFS.xls

Texas

2011 Fee Schedule:  http://www.trailblazerhealth.com/Tools/Fee%20Schedule/Downloads/Medicare/FS11TX11.pdf

2012 Fee Schedule:  http://www.trailblazerhealth.com/Tools/Fee%20Schedule/Downloads/Medicare/FS11TX12.pdf

Oklahoma

2011 Fee Schedule:  http://www.trailblazerhealth.com/Tools/Fee%20Schedule/Downloads/Medicare/FS06OK11.pdf

2012 Fee Schedule:  http://www.trailblazerhealth.com/Tools/Fee%20Schedule/Downloads/Medicare/FS06OK12.pdf