CMS Proposed Physician Fee Schedule Includes Expansion for Telehealth Services

On July 7, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017. This year, CMS is proposing a number of new physician fee schedule policies that will improve Medicare payment for those services provided by primary care physicians for patients with multiple chronic conditions, mental and behavioral health issues, and cognitive impairment or mobility-related disabilities.


Among the various proposals, CMS modifications to the Medicare Shared Savings Program to update the quality measures set and align with the proposals for the Quality Payment Program, changes to take beneficiary preferences for ACO assignment into consideration, and changes that would improve beneficiary protections when ACOs are approved to use the skilled nursing facility (SNF) 3-day waiver rule.  The CY 2017 PFS proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a health care system that results in better care, smarter spending, and healthier people.


CMS is proposing to add several codes to the list of services eligible to be furnished via telehealth.  These include:

  • End-stage renal disease (ESRD) related services for dialysis;
  • Advance care planning services;
  • Critical care consultations furnished via telehealth using new Medicare G-codes.

CMS is also proposing payment policies related to the use of new place of service code specifically designed to report services furnished via telehealth. 


Under the Medicare Diabetes Prevention Program CMS seeks comment on the quality metrics that should be reported by entities in addition to the reporting elements required on Medicare claims submissions outlined above (attendance and weight loss) or by the CDC recognition program. CMS specifically seeks comment on what quality metrics should be considered for public reporting (not for payment) to guide beneficiary choice of entities.


The full proposed rule is available at the in the Federal Register here.  CMS will accept comments on the proposed rule until September 6, 2016.