Medicare Fees Increase (for some)

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. 

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.

ZoneCodesParNon-ParLimiting Charge
12989409894198942$28.96$41.33$54.01$27.51$30.26$51.31$31.64$45.15$59.01
15989409894198942$30.35$43.22$56.27$28.83$41.06$53.46$33.15$47.22$61.48
16989409894198942$30.36$43.16$56.27$28.84$41.00$53.46$33.17$47.15$61.48
99989409894198942$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.

About Author

Mario Fucinari DC, CCSP, APMP, MCS-P, CPCO

Dr. Mario Fucinari has helped train doctors and staff over the last 20 years. He received his bachelor's degree from Wayne State University in Detroit and his Doctor of Chiropractic degree from Palmer College of Chiropractic in 1986. Dr. Fucinari was the recipient of the 1998 and the 2003 President's Award from the Illinois Chiropractic Society (ICS) for his work with education and training and most recently received the 2012 Chiropractor of the Year award from the ICS.

Dr. Fucinari was the first chiropractic physician to attain the Certified Medical Compliance degree. Two years later he earned his degree as a Certified Instructor for the Certified Medical Compliance Program. He is now the Chairman of the Chiropractic division of the national medical compliance program. He has produced classes and publications on HIPAA, Clinical Documentation, Medicare, and Stroke and Cervical Manipulation. He is a worldwide speaker for NCMIC, Foot Levelers, ChiroHealthUSA and several state associations and a Certified Chiropractic Sports Physician [CCSP].


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