Medicare Fees Increase (for some)
Congress passed the Bipartisan Budget Act of 2018 on 2/9/2018, changing the Medicare physician fee schedule and the processing of Medicare services. Section 50201 of this Act has made a change to the work Geographic Practice Cost Index (GPCI) floor, effective retroactive to 1/1/2018. Any area that previously was in an area with a work GPCI of less than 1.000 will be impacted. The Act issues a floor of 1.000 to the work GPCI which will cause any fee schedule for any service in those areas to have fees increase.
What does this mean to you?
Certain zones (Zone 12 and 99) will see reimbursement fees increase.
Advertisement
Keep in mind that the fees you receive may be impacted by your status as a participating provider or a non-participating provider and any penalties levied against you for failure to do PQRS coding properly and EHR Meaningful Use. The sequestration reduction of 2% will continue through 2027.
Fee Schedule Effective March 1, 2018, Retroactive to January 1, 2018.
| Zone | Codes | Par | Non-Par | Limiting Charge |
| 12 | 989409894198942 | $28.96$41.33$54.01 | $27.51$30.26$51.31 | $31.64$45.15$59.01 |
| 15 | 989409894198942 | $30.35$43.22$56.27 | $28.83$41.06$53.46 | $33.15$47.22$61.48 |
| 16 | 989409894198942 | $30.36$43.16$56.27 | $28.84$41.00$53.46 | $33.17$47.15$61.48 |
| 99 | 989409894198942 | $28.35$40.66$53.07 | $26.93$38.63$50.42 | $30.97$44.42$57.98 |
Editor’s Note: Please note the above chart does NOT reflect penalty reductions for EHR and PQRS. These penalties MUST be considered when billing the patient. You can watch a video on how to find these amounts here: https://youtu.be/JxSdAgu_Rpo.
