SGR Reform Fix

2015 Medicare fee schedule offers new care coordination, telehealth codes

Primary care providers will receive more payments for care coordination and telehealth services under the 2015 Medicare Physician Fee Schedule (PFS) released by the Centers for Medicare and Medicaid Systems (CMS) October 31.

Physicians will be able to receive $40.39 per month per qualifying patient for care coordination management starting in January 2015. Services include non-face-to-face planning and management for patients with two or more chronic conditions.

The 2015 rule also includes payment codes covering additional telehealth services, including annual wellness visits and prolonged evaluation and management services. In total, CMS added seven new telehealth payment codes.

The threat of sustainable growth rate (SGR) cuts still loom as physicians face a 21.1% reimbursement reduction unless another patch or a permanent fix to the rate formula is made before March 31. Just four days before last year’s SGR patch was to expire, lawmakers approved another year-long fix to the formula.

CMS also shows flexibility in its electronic health record (EHR) incentive program. The agency is allowing practitioners to bill for services provided under the new chronic care management codes from a 2013-certified EHR system, if they haven’t upgraded to a 2014-certified system.

The 2015 PFS also features four changes to the Sunshine Act, to take place starting in 2016. Among them is elimination of the exemption for reporting payments for continuing education speaking fees. Closing this loophole will be “more consistent for consumers who will ultimately have access to the reported data,” according to a fact sheet on the fee schedule released by CMS.