CMS proposes 2018 payment and policy updates for the Physician Fee Schedule

The overall update to payments under the PFS based on the proposed CY 2018 rates would be +0.31 percent. The Clinical Laboratory Fee Schedule (CLFS) final rule entitled “Medicare Program: Medicare Clinical Diagnostic Laboratory Tests Payment System requires extensive revisions to the Medicare payment, coding, and coverage for Clinical Diagnostic Laboratory Tests (CDLTs) paid under the CLFS. Under the final rule, the payment amount for a test on the CLFS furnished on or after January 1, 2018, generally will be equal to the weighted median of private payer rates determined for the test, based on the data of applicable laboratories that is collected during a specified data collection period and reported to CMS during a specified data reporting period. CMS is seeking comments from applicable laboratories and reporting entities regarding their experience with the first data collection and reporting periods under the new private payer rate-based CLFS. Comments received will be used to inform CMS regarding potential refinement to the CLFS for future data collection and reporting periods. In May 2017, CMS posted the operational list of patient relationship categories that are required under MACRA. In this rule, CMS is proposing the use of Level II HCPCS modifiers on claims to indicate these patient relationship categories. Further, they are proposing that the HCPCS modifiers may be voluntarily reported by clinicians beginning January 1, 2018. They anticipate that there will be a learning curve with respect to the use of these modifiers, and they will work with clinicians to ensure their proper use.


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