Government and Regulations

Fee schedule: Medicare gives details on care coordination pay, SGR cut



Starting Jan. 1, 2015, Medicare will pay physicians about $42 for certain care management services outside of the face-to-face office visit, according to a new government proposal.

The proposed rule for the 2015 Medicare Physician Fee Schedule, released on July 3, offers details on how officials at the Centers for Medicare & Medicaid Services (CMS) plan to roll out the new chronic care management services payments that begin in 2015. The proposal also expands telehealth services offered by Medicare and makes changes to the Open Payments program.

Dr. Reid Blackwelder

CMS proposes to pay $41.92 for a new G-code for chronic care management services provided to patients with two or more chronic conditions that are expected to last at least a year. The code could be billed only once a month for each patient.

To bill for the code, physicians would have to offer some type of 24/7 access, continuity of care, care management for chronic conditions including medication reconciliation, creation of a patient-centered care plan, management of care transitions including visits to the hospital and emergency department, and coordination with community-based services.

In the 2015 Physician Fee Schedule, CMS is also proposing to require that physicians use certified electronic health record technology.

The American Academy of Family Physicians (AAFP), members of which would benefit from the coding change, applauded CMS for proposing the care management code. But the AAFP said the benefit of the code would be overshadowed were Congress to allow the scheduled cut to the Medicare Sustainable Growth Rate (SGR) formula to go into effect on April 1, 2015.

The fee schedule proposal reiterates that physicians will face a 20.9% across-the-board fee cut next year if Congress does not repeal or postpone the SGR.

"The AAFP welcomes the new code but we also look to a day when policies designed to strengthen primary medical care are not undermined by drastic cuts to the underlying foundation on which all payment is based," Dr. Reid Blackwelder, AAFP president, said in a statement.

The proposed fee schedule also seeks to add annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management services to the list of telehealth services that can be furnished to Medicare beneficiaries under the telehealth benefit.

Medicare also proposes to redefine screening colonoscopy to include anesthesia. With this proposed change, Medicare beneficiaries would not have to pay coinsurance on the anesthesia portion of the procedure when it is provided separately by an anesthesiologist.

CMS is also planning to make changes to the Open Payments program, which requires drug and device manufacturers to report on the payments and transfers of value made to physicians and teaching hospitals.

Agency officials want to completely exclude reporting on continuing medical education payments made by industry. Under the current framework, CMS excluded most CME reporting, if the event met the accreditation or certification requirements of five organizations. However, the proposal would broaden that provision to include any CME event in which the industry provides funding but is not involved in selecting or paying speakers. If finalized, the changes would take effect in 2015.

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