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12/15/2016

Medicare 2017 Fee Schedule Now Available!

Rates Effective January 1, 2017 - December 31, 2017

WPS Medicare recently released the 2017 fee schedule for dates of service January 1 – December 31, 2017. The new fee schedule reflects changes passed by Congress in the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. MACRA repealed the Sustainable Growth Rate (SGR) formula, the cause of potential huge cuts to the fee schedule providers have been dealing with for more than a decade.

Locality 01 (Macomb, Oakland, Washtenaw, and Wayne Counties)

  Procedure Code Par Amount Non-Par Amount Limiting Charge
Non-Facility 98940 $28.99 $27.54 $31.67
  98941 $41.52 $39.44 $45.36
  98942 $54.24 $51.53 $59.26
         

Locality 99 (All Other Michigan Counties)

  Procedure Code Par Amount Non-Par Amount Limiting Charge
Non-Facility 98940 $27.78 $26.39 $30.35
  98941 $40.06 $38.06 $43.77
  98942 $52.35 $49.73 $57.19
         
Medicare Deductible for 2017: $183


Electronic Health Records Incentive Program Penalties

All Medicare eligible professionals who do not adopt and successfully demonstrate meaningful use (MU) of a certified electronic health record (EHR) technology are subject to a reduction in the Medicare physician fee schedule amount for covered professional services.

The adjustment for 2017 (based on demonstration of MU in 2015) is 98% of the Medicare physician fee schedule covered amount. Providers could face additional decreases in 2018 and each subsequent year, based on demonstration of MU in 2016 and subsequent years. Depending on the total number of Medicare eligible professionals who are meaningful users under the EHR Incentive Programs after 2018, the maximum payment adjustment can reach as high as 5%.


Physician Quality Reporting System (PQRS) Payment Adjustments

Eligible professionals who do not satisfactorily report data on quality measures for covered professional services will be subject to a continued payment adjustment under PQRS in 2017.

The PQRS payment adjustment applies to all of the eligible professional’s Part B covered professional services under the Medicare Physician Fee Schedule (PFS). For 2017 and subsequent years (based on participation in 2015 and subsequent years), the payment adjustment is 2.0%.

Expanded Medicare Fee Schedule Available

If you did not participate in the EHR Incentive Program, PQRS, or either program, an expanded Medicare fee schedule reflecting the above penalties for 2017 is available to MAC MEMBERS ONLY. Contact Tim at the MAC office at tim@chiromi.com or (517) 367-2225  or visit the Medicare section of this website for the expanded fee schedule.

Source: WPS Medicare

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