2019 Medicare Fee Schedule, MIPS Update, and More

2019 Medicare Fee Schedule, MIPS Update, and More

A few weeks ago, the Centers for Medicare and Medicaid Services (CMS) released their final rule for 2019. In that release, CMS included the 2019 Medicare fee schedule, a change to the MIPS participation rules, and significant changes to evaluation and management coding and documentation.

Fee Schedule:

The 2019 Medicare fee schedule is now available and can be accessed here (if the site requires sign in, simply choose sign in as a guest and re-click the link above). The ICS has prepared a video to walk you through finding your Medicare fees for 2019 – click here for that video. You can find your Medicare Locality in the list at the bottom of this article.

E&M Changes:

CMS made what they refer to as historic changes to evaluation and management billing and documentation for Medicare patients.

The key changes that will impact most of our doctors beginning in 2019 are as follows:

• Chief complaint and history – There no longer is a requirement to re-enter that information in documentation, but, instead, providers should document that the information was reviewed and verified.
• Established patient E&M –Once relevant information is included in the medical record, physicians may focus their documentation on changes that have occurred since the previous visit, or on pertinent facts that have not changed. Physicians will still need to review and update prior information as necessary and document in the medical record that they have done so.
• 2021 will bring even more changes that will combine level 2-4 exams to one payment, create documentation standards, allow physicians to document based on time, and create a few add-on codes. The ICS will cover more of these changes over the next few years by providing education to prepare our doctors for these changes effective in 2021.

MIPS Participation Thresholds:

CMS made two important changes to the thresholds for MIPS participation. In years past, a provider who rendered more than $90,000 in covered services AND saw 200 Medicare patients in a year was required to participate in MIPS. However, a provider who met one of those two requirements could choose to participate.

The new changes added a third threshold – the provider or group must provide more than 200 professional services to Medicare Part-B patients. Therefore, providers must meet ALL three conditions to be required to participate in MIPS.

However, as before, providers may choose to participate in MIPS if they meet any of the three requirements. Seeing that many of our providers will now be able to meet the new third threshold (200 services), we anticipate more providers may choose to participate in MIPS. If you choose to participate in MIPS, we would encourage you to check out our upcoming Medicare courses and our online MIPS course.

Which locality am I?

If you are uncertain as to your locality, Medicare divides the different states into several geographic Localities based on the location of your practice. Illinois consists of payment localities 12, 15, and 16, and 99. A listing of the counties comprising each payment locality follows:

Locality 12

  • Bond
  • Calhoun
  • Clinton
  • Jersey
  • Macoupin
  • Madison
  • Monroe
  • Montgomery
  • Randolph
  • St. Clair
  • Washington

Locality 15

  • DuPage
  • Kane
  • Lake
  • Will

Locality 16

  • Cook

Locality 99

• All other counties

About Author

ICS Staff

The Illinois Chiropractic Society staff works collaboratively on many topics to bring the most comprehensive and relevant information to our members. We have over 60 years of chiropractic experience and understand the heartbeat of the profession. We all look forward to providing relevant information to our members for years to come.

Recent Videos


Corporate Club


Article Categories