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CMS Proposes 2019 Payment Rule for Physicians

July 13, 2018

On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) issued its CY 2019 proposed payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule. Payment rates and policies will be effective Jan. 1, 2019, once finalized. 

SNMMI is reviewing the 1,473 page proposed rule and will prepare a detailed summary as well as payment rate charts. The Society will submit comments by the end of the comment period, which closes September 10, 2018. 

Important highlights:

  • With the budget neutrality adjustment to account for relative value changes (required by law), the proposed 2019 PFS conversion factor is $36.05, a slight increase above the 2018 PFS conversion factor of $35.99.
  • CMS has proposed January 1, 2020, as the target start date of the Medicare Appropriate Use Criteria (AUC) Program.
  • CMS is proposing to add independent diagnostic testing facilities (IDTFs) to the definition of an "applicable setting" for the purpose of AUC-consulting and reporting requirements.
  • When physicians report an E/M service and a procedure on the same date, CMS proposes to implement a 50% multiple procedure reduction to the lower paid of the two services.
  • CMS is proposing they accept the RUC recommendation for CPT 77081 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) current RVW 0.22 reduced to 0.20 RVWs, and proposed to accept the PE inputs from the RUC recommendations. If implemented, it will reduce payment for these services in CY 2019.

Proposed rule

Proposed rule fact sheets