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    CMS Proposed 2017 Physician Fee Schedule: What Interventionalists and Cath Labs Need to Know

    July 14, 2016

    The Proposed 2017 Physician's Fee Schedule was recently released by the Centers for Medicare & Medicaid Services (CMS). This schedule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017.

    CMS estimates that the net effect of these changes to cardiologists will be a 1% fee increase in 2017. Here are the key findings that will potentially affect the interventional cardiovascular community:

    • SCAI Obtains New Procedure Codes; CMS Proposes Lower Work Values:  While SCAI was successful in getting a variety of new current procedural terminology (CPT) codes adopted for 2017, CMS is proposing work values that are about 10% less than recommended by the AMA and SCAI.

    • STEMI PCI Targeted as Potentially Misvalued: CMS has targeted the STEMI PCI code as being potentially misvalued due to frequent claims for same day Evaluation & Management reporting. SCAI will be responding to CMS’ proposal with data and possibly with suggestions of alternative solutions to what CMS perceives as inappropriate billing for E&M procedures in conjunction with primary PCIs.

    • Moderate Sedation Cleaved Out to be Separately Reported: CMS is also moving forward with stripping out the value of performing moderate sedation (deemed to be 0.25 relative value units) from ALL codes for which it is considered inherent, which will force providers to separately report this work using new moderate sedation codes.

    SCAI will continue to review the proposed schedule and will provide more information as it pertains to the specialty. We encourage members to provide their feedback on the proposed rulings as we begin to develop comment letters for submission to the CMS. For coding and reimbursement questions and concerns, please contact Dawn R. Gray at dgray@scai.org. For MACRA and other issues related to this proposed schedule, please contact Wayne Powell at wpowell@scai.org.