On July 12, 2018, CMS released the unpublished version of the Calendar Year (CY) 2019 Proposed Physician Fee Schedule (PFS), which can be found here while the Fact Sheet is available here. The CY 2019 Proposed PFS reflects a response by CMS to stakeholder feedback regarding the need to streamline documentation requirements for Evaluation and Management (E&M) visits. There are currently four levels of E&M billing with different documentation requirements needed to support each level. CMS currently requires the requisite code documentation for E&M visits in order for the physician to be paid for the visit. CMS is proposing to eliminate the different levels in exchange for a single E&M coding level. CMS expects this change to reduce payments to specialists who bill at the highest E&M level, although revenue loss could be offset by the time savings to the clinicians, who will be able to see more patients. CMS estimates that this proposal “would save individual clinicians an estimated 51 hours per year if 40 percent of their patients are in Medicare.” 

Another major area of change in the CY 2019 PFS proposed rule is the proposed expansion of telemedicine reimbursement. The proposed rule would allow billing for a non-face-to-face consult between an established physician and patient to determine whether an E&M visit is necessary. The CY 2019 PFS proposed rule also proposes establishing a code to permit Medicare payment when a physician uses a recorded video or image captured by a patient in order to evaluate a patient’s condition and potential need for an E&M visit. For the non-face-to-face consult, as well as the recorded video or image consult, the service would not be separately billable by the physician if the remote service originates from a related E&M visit within the previous seven days, or if the consult results in an E&M visit within the next 24 hours. In these instances, the consult would be bundled into the E&M visit. Where separately recoverable, these remote consults would be reimbursed at a lesser rate than traditional E&M visits in light of the reduced overhead cost of these visits and the efficiencies associated with the use of communication technology.

CMS has not set a frequency limitation on the number of times a physician can recover for remote visits associated with the same patient, but seeks input from stakeholders on whether a frequency limitation should be imposed. CMS also seeks input from stakeholders on whether a physician/patient relationship should be required before the physician can submit for reimbursement for a consult based on review of a recorded video or image sent by the patient to determine if an in-person E&M visit is necessary. These are just a few areas in which CMS requests feedback during the comment period. Other areas where CMS is requesting feedback can be found throughout the proposed rule.

Comments on the CY 2019 PFS proposed rule are due by 5 p.m. ET on September 10, 2018.