CMS Issues Final CY 2013 Medicare Physician Fee Schedule (MPFS) Rule


On November 1, 2012, CMS issued the final Medicare physician fee schedule (MPFS) rule for calendar year (CY) 2013.  This rule, among other things, is expected to increase payment to family physicians by 7% and other primary care physicians between 3% – 5% so long as Congress overrides the statutorily required Sustainable Growth Rate (SGR) reduction (as it has done every year since 2003).

Other changes in the MPFS final rule include:

  • (in the absence of Congressional action) a 26.5% across-the-board reduction to Medicare payment rates for physicians and non-physician practitioners, as required under the Balanced Budget Act’s SGR methodology;
  • a new procedure to pay for the management of a patient’s care for the 30 days following a hospital or skilled nursing facility stay; 
  • the implementation of a physician value-based payment modifier, to be phased in over three years from 2015-2017, providing differential Medicare payments to physicians based on comparison of the quality and the cost of care, and enlarging the group size for whom the modifier applies from groups of physicians with 25 or more eligible professionals to groups of 100 or more;
  • a choice for these groups to select the method for calculating the modifier based on their participation in the Physician Quality Reporting System (PQRS); 
  • changes to the PQRS and the Electronic Prescribing (eRx) Incentive Program, the two MPFS-applicable quality reporting programs;
  • updates to the Medicare Electronic Health Records (EHR) Incentive Pilot Program;
  • allowing Medicare to pay for portable x-rays ordered by non-physician practitioners;
  • details on how Medicare will pay for molecular pathology services under the Clinical Laboratory Fee Schedule;
  • an expansion of access to non-physician practitioner services;
  • the ability for Medicare to pay Certified Registered Nurse Anesthetists (CRNAs) for a requirement of an in-person encounter for some durable medical equipment (DME) items for orders written on or after July 1, 2013 as a condition of payment; and
  • efforts to enhance the Physician Compare website, including, as part of the Million Hearts campaign, the names of practitioners who effectively report heart-disease prevention measures.

The rule will be published in the Federal Register on November 16, 2012 and will take effect January 1, 2013, with a comment period closing on December 31, 2012.  For the final MPFS rule, click here

Reporter, Katy Lucas, Atlanta, +1 404 572 2822,

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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