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November 17, 2015

The Centers for Medicare & Medicaid Services (CMS) finalized the Medicare physician fee schedule (PFS) for 2016.

The final rule:
• Sets 2016 Medicare payment rates for physician services, including a 0.5% payment increase as a result of SGR repeal under the Medicare Access and CHIP Reauthorization Act (MACRA).
• Establishes criteria for the 2016 performance year for the value-based payment modifier (VBPM), which could result in penalties of 4% in 2018 for high cost/low quality providers;
• Details criteria for 2016 performance in PQRS to avoid a 2% penalty in 2018;
• Increases the amount of information about physicians and practices on the Physician Compare website, including information pertaining to quality measure performance; and
• Clarifies billing guidance for incident-to services without any major changes.
In a separate rule, CMS finalized changes to policies and payments regarding hospital outpatient and ambulatory surgical centers.

Follow the link below to view the full final 2016 Medicare PFS. CMS also released a fact sheet on the final PFS.

Final 2016 Medicare PFS

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