CMS Issues Medicare Physician Fee Schedule Proposed Rule.

Date posted: July 31, 2015

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule updating payment rates, policies, and quality provisions under the Medicare Physician Fee Schedule (MPFS) for Calendar Year (CY) 2016.  Among other things, the proposed rule implements the new payment system for physicians and other practitioners, titled the Merit-Based Incentive Payment System (MIPS), required by the Medicare Access and Children’s Insurance Program Reauthorization Act of 2015.  The MIPS will replace the Physician Quality Reporting System (PQRS), beginning with payments for items and services furnished on or after January 1, 2019.

Key highlights of the proposed rule include:

  • Public reporting of measures on the Physician Compare website, including individual and group-level qualified clinical data registry, Value Modifier tier ratings for cost and quality, and item or measure-level benchmarks, which will be displayed as a five star rating;
  • A separate payment and a payment rate for two advance care planning services provided to seniors and other Medicare beneficiaries by physicians and other practitioners;
  • Revaluation of lower gastrointestinal endoscopic procedure codes based on data about the provision of moderate sedation associated with the services;
  • Clarification of “incident to” rules, requiring that: (1) the billing physician or practitioner for “incident to” services must also be the supervising physician or practitioner; and (2) that auxiliary personnel providing “incident to” services and supplies cannot have been excluded from Federal health care programs or have had their enrollment revoked;
  • Expansion of the Comprehensive Primary Care Initiative; and
  • Value-based payment modifier changes.

Notably, the proposed rule also includes changes to the physician self-referral law, including a new exception to permit payment to physicians for the purpose of employing nonphysician practitioners. CMS also proposes the following changes to the physician self-referral law to:

  • Clarify that the term of a lease or personal services arrangement is not required to be in writing if the arrangement lasts at least 1 year and is otherwise compliant;
  • Allow expired leasing and personal services arrangements to continue on the same terms if otherwise compliant;
  • Allow a 90-day grace period to obtain missing signatures without regard to whether the failure to obtain the signature was inadvertent;
  • Clarify that a financial relationship does not necessarily exist when a physician provides services to patients in the hospital if both the hospital and the physician bill independently for their services; and
  • Establish a new exception to permit timeshare arrangements for the use of office space, equipment, personnel, supplies and other services that will benefit rural or underserved areas.

CMS will accept comments on the proposed rule until September 8, 2015.  CMS will release a final rule by November 1, 2015.

The proposed rule is available at:

The CMS fact sheet is available at:

Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2016; Proposed Rule, 80 Fed. Reg. 135, 41686-41966 (July 15, 2015).

The Centers for Medicare & Medicaid Services.  “Proposed Policy, Payment and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2016.”  Fact Sheet.  8 Jul. 2015.

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