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CMS Proposes Simplified E/M Reimbursement

Posted in Legislation and Public Policy, Medicare and Medicaid, Reimbursement Matters

The Centers for Medicare & Medicaid Services’ (CMS’s) proposed rule containing revisions to the Medicare Physician Fee Schedule for 2019, released on July 12, proposed a simplified payment system for patient evaluation and management (E/M) services. The proposal would replace the existing five Medicare reimbursement levels for both new and existing patient visits with a single payment rate for each.Reimbursement for new patient visits, which currently range from $76 for a level 2 visit to $211 for a level 5 visit, would be replaced with a single $135 rate. Visits with established patients, which are currently reimbursed at $22 for a level 2 visit and up to $148 for a level 5 visit, would all be paid at $93 per visit under the proposal. Reimbursement for level 1 visits, for nonphysician services, would remain unchanged. Levels 2 through 5 reflect increasingly complex levels of care.
Some industry participants have expressed concern that physicians who treat a disproportionate number of patients with complex needs will be undercompensated if the changes go into effect. Recognizing this issue, CMS has provided in the proposal for additional payments for prolonged visits ($67 per additional half-hour) and a $14 add-on payment for many specialist services.

Comments on the proposal are due by September 10. If finalized, the changes would become effective in January 2019.

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