Greater payment for primary care, chronic care management, and telehealth services are among the changes that will go into effect in January as a result of final 2017 physician fee schedule recently released by the Centers for Medicare & Medicaid Services (CMS). Payment for physicians and other practitioners is made under this fee schedule.
- Care Coordination: Primary care services such as chronic care management, care coordination and planning, and care for cognitive impairment will receive increased reimbursement under the rule. Such changes are intended to reward clinicians who are making time and resource investments in more coordinated, patient-centered care, according to CMS.
- Telehealth: Several services provided via telehealth will become eligible for payment, including:
- End-stage renal disease related services for dialysis;
- Advance care planning services;
- Critical care consultations furnished via telehealth using new Medicare G codes.
CMS also approved payment policies related to the use of a new-place-of-service code designed to report services furnished via telehealth.
- Mammography: CMS is implementing new coding for mammography to reflect current technology, including a transition from film to digital imaging and elimination of separate coding for computer aided detection services. The technical component for mammography services is not being changed. CMS is implementing the new coding framework and descriptors through use of G-codes for Medicare.
- Prevention: CMS is expanding the Diabetes Prevention Program starting in January, 2018. This is a structured lifestyle intervention program that uses dietary coaching and physical activity to help prevent the onset of diabetes in those who are pre-diabetic.
- Appropriate Use: The CMS rule further implements a 2014 law requiring physicians to consult appropriate use criteria when ordering advanced diagnostic imaging services. The rule identified a number of priority clinical areas for use of such criteria—coronary artery disease, suspected pulmonary embolism, headache, hip pain, low back pain, shoulder pain, lung cancer, and cervical or neck pain. CMS said that it would not require clinicians to begin consulting appropriate use criteria and appending this information to Medicare claims forms before January 1, 2018.