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Final 2018 Medicare Rates for Physician, Hospital Outpatient Payment

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November 6, 2017

Final 2018 Medicare Rates for Physician, Hospital Outpatient Payment


Physicians, hospital outpatient departments, and ambulatory surgery centers will all see increases in Medicare payments in Calendar Year 2018.  The Centers for Medicare & Medicaid Services (CMS) recently issued final payment and policy regulations for each.




Payments:  CMS will increase payments to physicians by 0.41% in 2018.  Total payments for hospital outpatient departments will rise 1.4%, and payments for ambulatory surgery centers will increase 3% overall.


Telehealth:  CMS is finalizing its decision to add several services to the list of those eligible to be furnished via telehealth:


  • Counseling to determine eligibility for low-dose CT lung cancer screening;
  • Health risk assessment;
  • Planning for chronic care management;
  • Crisis psychotherapy; and
  • Interactive complexity during a psychiatric evaluation.


CMS will no longer require physicians to use the telehealth modifier GT for claims.  It also approved separate payment for CPT code 99091, which involves remote patient monitoring.  The agency said it is also considering ways within its current authority to further expand access to telehealth.


Appropriate Use: The appropriate use criteria (AUC) program for advanced imaging services will start with an educational and operations testing year in 2020.  Physicians will be required to begin using AUCs and reporting them on their claims, but CMS will pay regardless of whether claims correctly contain such information.  CMS says this permits both physicians and CMS to prepare for the new program.


  • A voluntary participation period will begin in mid-2018 through 2019, allowing physicians to begin exploring the qualified clinical decision support systems—the tools that allow physicians to access AUC.  CMS will collect limited information on Medicare claims to identify advanced imaging services for which consultation with appropriate use criteria took place.

  • CMS says that clinicians who use these support mechanisms may earn credit under the Merit-Based Incentive Payment System (MIPS) that is part of MACRA, the Medicare Access and CHIP Reauthorization Act.


Site Neutral Payments:  2018 reimbursement for certain hospital outpatient departments that acquire off-campus physician practices will be cut by 20% from the 2017 rates, which were themselves reduced by 50% and paid under the less-lucrative physician fee schedule. CMS grants some exceptions:


  • If the facility is within 250 yards of a hospital remote location.
  • If the facility is a dedicated emergency department.
  • If the care was billed before November 2, 2015.


X-Rays:  Payment in the hospital outpatient setting for imaging services “using computed radiography technology,” will be cut by 7% for years 2018 – 2022 and 10% starting in 2023.  For 2018, CMS will establish a new coding modifier for claims for x-rays using computed radiography.

View CMS fact sheet on hospital outpatient rule

View CMS fact sheet on physician fee schedule rule

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