Primary Care
Coding Alert – Proposed 2017 Medicare Physician Fee Schedule

CMS released a proposed 2017 Medicare Physician Fee on July 7, 2016.  The proposed rule updates payment rates and certain payment policies for services provided by physicians and other healthcare professionals who will be paid under the physician fee schedule for 2017. 

The 2017 proposed rule includes recommendations that would allow separate reimbursement for certain non-face-to face prolonged Evaluation and Management services. It also provides for separate reimbursement for comprehensive assessment and care planning and chronic care management for patients with greater complexity. 

  • In addition, CMS proposes coverage for four new category I codes created to replace category III codes 0171T-0272T.
  • Seven new HCPCS G codes related to behavioral health and episodic care management services have been created. 
  • Eight new unpaid G codes were established for physicians to report services provided during a global period.
  • CMS also proposes to separate reimbursement for moderate sedation from many GI endoscopic procedure codes and has created a new HCPCS code to report moderate sedation services provided by the same physician who performed the GI endoscopic service.

Details on these proposed changes include –

  • Prolonged E / M services without direct patient contact –
    • CMS is proposing to make separate payment for CPT codes 99358 and 99359 for 2017.
  • Complex Chronic Care Management Services (CCM) –
    • CMS is proposing to change the status on codes 99487 and 99489 from their current status B (bundled) to A (active) to allow separate reimbursement for these services. 
  • Category III updates –
    • Lumbar spinal distraction device category III codes 0171T and 0172T were converted to four new category I codes (228X1 - 228X5) by the CPT Editorial Panel for 2017. 
  • Behavioral health and episodic care management services –
    • As CMS expands how it reimburses providers for ongoing coordination of a patient’s care, the proposed rule includes seven new G codes for reporting these services (GPPP1, GPPP2, GPPP3, GPPP6, GPPP7, GPPPX, and GDDD1).
  • ​Global surgery data –
    • CMS will begin to capture data global service data in 2017 in order to obtain accurate values for global period services.  This is part of the agency’s proposal to phase out surgical global periods in future years.  MACRA requires CMS to begin to revalue global surgery codes beginning in 2019.
      • HCPCS codes GXXX1-GXXX8 are unpaid time based codes created for reporting visits and other services provided during a global period.
      • If CMS finds that providers are not reporting these codes they may consider withholding 5% of the providers’ payments in order to ensure compliance.
  • Moderate Sedation for GI Endoscopic procedures –
    • CMS created an add-on HCPCS code GMMM1 code for reporting by gastroenterologists who provide moderate sedation for their GI Endoscopic procedures.

Complete information on the 2017 Proposed Rule updates can be found on the CMS website. CMS allowed providers until 5:00 pm on September 6, 2016 to respond to the proposed rules.  The 2017 Medicare Physician Fee Schedule final rule will then be released in November, so stay tuned for further updates in November!

If you have coding questions, contact your Provider Coordinator. We’re happy to help.


View List of ​Fall 2016 Unity Communicator Articles