Anticipated Changes to the Medicare Physician Fee Schedule for 2019


Medicare Physician Fee Schedule for 2019

Medicare will begin raising their payments by .12% beginning January 2019 as a part of their strategy to increase accessibility, quality, and affordability. On July 12, 2018, Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions. These three elements will be issued under the Medicare Physician Fee Schedule (PFS).

“Payments are based on the relative resources typically used to furnish the service. Relative Value Units (RVUs) are applied to each service for physician work, practice expense, and malpractice. These RVUs become payment rates through the application of a conversion factor. Payment rates are calculated to include an overall payment update specified by statute.”

2019 Change Headliners

  • Streamlining Evaluation and Management (E/M) Payment and Reducing Clinician Burden by allowing practitioners to choose how to document E/M visits, factor in duration of visit, and reduce the amount of documentation entries needed.
  • Recognizing Communication Technology-Based Services, such as virtual check-in’s, remote evaluations, and telehealth services.
  • Establishing two new therapy modifiers for PT Assistants and OT Assistants.
  • Increasing the 2019 Conversion Factor (CF) to $36.05 from 2018’s $35.99.
  • Overhauling the MIPS “Promoting Interoperability” performance category to support greater EHR interoperability and patient access to their health information.


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Resources & Credits:
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Visit CMS.GOV for the full Medicare Physician Fee Schedule Proposal

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