Proposed rule for MPFS payments

October 2017 - Vol. 36, No. 09

On July 13, 2017, the Centers for Medicare & Medicaid Services (CMS) posted the proposed rule for payments in the Medicare physician fee schedule (MPFS) for calendar year (CY) 2018. In addition to payment and policy updates, the MPFS addresses a number of issues affecting otolaryngologist – head and neck surgeons. In the rule, CMS proposes values for the newly developed Endoscopic Sinus Surgery (ESS) and sinus ostial dilation (e.g., balloons) codes developed in conjunction with the American Rhinologic Society (ARS) and the American Academy of Otolaryngic Allergy (AAOA).

CMS also proposes values for a number of other codes, discusses possible revisions to E/M guidelines, outlines provisions for Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging starting in 2019, aligns the Physician Quality Reporting System (PQRS) and Value-based Payment Modifier (VBM) programs with Merit-based Payment System (MIPS) reporting criteria, and proposes new modifiers for patient relationship categories required under MIPS.

The Academy submitted comments to CMS on the proposed rule on September 1, 2017, and is available at http://www.entnet.org/content/regulatory-advocacy. Watch for the November Bulletin for a deeper explanation of what you need to know about proposals in the MPFS and how the Academy is advocating on your behalf.