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Medicare Proposes 2019 Physician Payment Policies

July 18, 2018

Medicare intends to cover telehealth services in more locations, for more uses, and with more reimbursement in 2019 under a proposed rule from the Centers for Medicare & Medicaid Services (CMS). The rule updates payment policies and rates for physicians in the calendar year starting January 1, 2019. CMS also proposes to make changes in the quality metrics of its Quality Payment Program that is being implemented as part of the 2015 MACRA law.

Public comments on the proposed rule are due by September 10, 2018, and CMS is expected to issue a final regulation in November.




Telehealth:  In an effort to expand access to virtual care for a variety of services and locations, CMS is proposing to:

Cover telehealth technologies used for prolonged preventive services that go beyond just the service time of the primary procedure.


  • Cover two newly defined physician services provided via telecommunications technology:  a virtual check-in to decide whether an office visit is needed; and remote evaluation of patient-transmitted video or images to determine whether a visit is needed.
  • Provide separate payment for new codes regarding remote patient monitoring for patients with chronic conditions and for internet or phone consultation among clinicians.
  • Cover telehealth services, without geographic restrictions, for the monthly clinical assessments of end-stage renal disease (ESRD) patients receiving dialysis in their homes or in dialysis facilities.
  • Add mobile stroke units as originating sites and not apply geographic requirements to diagnosing, evaluating, or treating symptoms of acute stroke.
  • Provide payment for rural health clinics and federally qualified health centers for communications-technology based services and remote evaluation even when there is no associated clinical visit.


Appropriate Use Criteria (AUC): CMS proposes to add independent diagnostic testing facilities (IDTFs) to the definition of applicable settings in which physicians are required to consult appropriate use criteria when they use advanced diagnostic imaging. Existing settings include physician offices, hospital outpatient departments, and ambulatory surgical centers.


Quality Payment Program: In the Merit-based Incentive Payment System (MIPS), which uses physicians’ performance to determine if they qualify for incentive payments, CMS proposes to remove process-based quality measures that clinicians have said are low-value in order to focus on measures that have a greater impact on health outcomes. Also, in determining physician performance in the MIPS category that focuses on meaningful use of certified EHR technology, the agency plans to require physicians to use the 2015 Edition certified EHR technology in 2019.


Site Neutral Payments: For 2019, CMS proposes that payments for procedures done in certain off-campus hospital outpatient provider-based facilities be set at 40% of what would have been paid under the Medicare hospital outpatient department payment rate. This is the same payment level as in 2018.


Radiologist Assistants: CMS proposes to reduce unnecessary physician supervision of radiologist assistants for diagnostic tests, allowing other personnel to supervise instead.


Evaluation and Management Visits: CMS intends to simplify, streamline, and offer flexibility in documentation requirements physicians must meet for evaluation and management visits.

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