Revisions to Payment Policies
under the Physician Fee Schedule
and Other Revisions to Part B for
CY 2018
A SIDE-BY-SIDE COMPARISON OF KEY PROVISIONS FROM THE PROPOSED AND FINAL RULES
FOR CY 2018
Table of Contents
Overview…………………………………………………………………………………………………………………………………………………………………………………….3
Provisions of the Final Rule for the PFS …………………………………………………………………………………………………………………………………………….4
Determination of Practice Expense Relative Value Units (PE RVUs) ……………………………………………………………………………………………………………………………………. 4
Determination of Malpractice Relative Value Units (MRVUs)…………………………………………………………………………………………………………………………………………….. 8
Medicare Telehealth Services………………………………………………………………………………………………………………………………………………………………………………………. 11
Proposed Potentially Misvalued Services Under the Physician Fee Schedule……………………………………………………………………………………………………………………… 14
Payment Incentive for the Transition from Traditional X-Ray Imaging to Digital Radiography and Other Imaging Services……………………………………………………… 16
Proposed Payment Rates under the Medicare PFS for Nonexcepted Items and Services Furnished by Nonexcepted Off-Campus Provider-Based Departments…. 16
Valuation of Specific Codes………………………………………………………………………………………………………………………………………………………………………………………….. 18
Evaluation and Management (E/M) Guidelines and Care Management Services………………………………………………………………………………………………………………… 20
Outpatient Therapy Caps for CY 2018 …………………………………………………………………………………………………………………………………………………………………………… 21
Other Provisions of the Proposed Rule for PFS …………………………………………………………………………………………………………………………………22
New Care Coordination Services and Payment for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)………………………………………………. 22
Part B Drug Payment: Infusion Drugs Furnished through an Item of Durable Medical Equipment (DME)………………………………………………………………………………. 25
Solicitation of Public Comments on Initial Data Collection and Reporting Periods for Clinical Laboratory Fee Schedule………………………………………………………….. 26
Payment for Biosimilar Biological Products under Section 1847A of the Act………………………………………………………………………………………………………………………. 27
Appropriate Use Criteria for Advanced Diagnostic Imaging Services…………………………………………………………………………………………………………………………………. 28
Physician Quality Reporting System (PQRS) Criteria for Satisfactory Reporting for Individual EPs and Group Practices for the 2018 PQRS Payment Adjustment… 35
Clinical Quality Measurement for Eligible Professionals Participating in the Electronic Health Record (EHR) Incentive Program for 2016…………………………………. 36
Medicare Shared Savings Program (MSSP)…………………………………………………………………………………………………………………………………………………………………….. 37
Value-Based Payment Modifier and Physician Feedback Program ……………………………………………………………………………………………………………………………………. 40
MACRA Patient Relationship Categories and Codes………………………………………………………………………………………………………………………………………………………… 41
Medicare Diabetes Prevention Program………………………………………………………………………………………………………………………………………………………………………… 43
Physician Self-Referral Law: Annual Update to the List of CPT/HCPCS Codes……………………………………………………………………………………………………………………… 48
Collection of Information Requirements …………………………………………………………………………………………………………………………………………49
Regulatory Impact Analysis…………………………………………………………………………………………………………………………………………………………..49
Appendices………………………………………………………………………………………………………………………………………………………………………………..53
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