CMS releases CY 2016 Physician Fee Schedule Final Rule

On October 30 of last year, CMS issued a final rule that updated payment policies and rates for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2016. This is the same schedule used to pay for Part B therapy services in senior-living and post-acute care communities.

According to the Polaris Group, highlights of the final rule include:

  • Estimated payment rate increase of 0.5%. This amounts to a conversion factor of $35.83, which reflects a 0.5% increase and budget neutrality adjustment of 0.7777 called for under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

  • Therapy cap increase to $1,960. The therapy cap amount for outpatient therapy services during CY 2016 is $1,960 for occupational therapy – and $1,960 for physical therapy and speech therapy combined. (The therapy cap exceptions process was extended through December 31, 2017 under MACRA.)

  • Finalizing updates to the "Two-Midnight" rule. The final rule clarifies when inpatient admissions are appropriate for payment under Medicare Part A. This continues CMS' emphasis on the importance of a physician's medical judgment in meeting the needs of Medicare beneficiaries by providing clearer guidelines and a more collaborative approach to education and enforcement.

Additional information
To view the 2016 Physician Fee Schedule Final Rule, please visit the Polaris Group website.


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