2016 Medicare Payment Update

November 10, 2015
Rick Gawenda

On October 30, 2015, the Centers for Medicare and Medicaid Services (CMS) issued “Proposed policy, payment, and quality provisions changes to the Medicare Physician Fee Schedule for Calendar Year 2016” final rule updating payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2016. CMS finalized a number of new policies, including several that are a result of recently enacted legislation. The rule also finalizes changes to several of the quality reporting initiatives that are associated with PFS payments, including the Physician Quality Reporting System (PQRS), the Physician Value-Based Payment Modifier (Value Modifier), and the Medicare Electronic Health Record (EHR) Incentive Program, as well as changes to the Physician Compare website on Medicare.gov.

Topics of interest in the final rule as they apply to outpatient therapy include:

  • 2016 therapy cap dollar threshold
  • 2016 PQRS measures
  • Conversion factor update that will impact payment rate to therapists
  • 10 perceived misvalued physical and occupational therapy CPT codes

The final rule will be published in the Federal Register on November 16, 2015. I will now provide a brief summary of the 4 bullet points mentioned above.

In 2016, the therapy cap dollar threshold will be

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