Highlights from the CMS 2017 Medicare Physician Fee Schedule

The CY 2017 Medicare Physician Fee Schedule Proposed Rule with comment period was placed on display on the Federal Register on July 7, 2016.

CMS has proposed some increases for pathology services including: pathology add-on services, micro-slide consultations, prostate G-code, and tumor immunohistochemistry.  However, the converse side shows a decrease to flow cytometry services.  Further analysis of the reimbursement rates reveal professional services somewhat maintaining 2016 rates, whereas the technical component taking the brunt of the decreases. 

Specifically, CPT 88341–26, is proposed to have a 9% increase and flow cytometry CPT codes (88184 thru 88189) have a proposed 19% decrease.  Furthermore, the G0416 prostate biopsy, any method is proposed to have a 17% increase to the professional component but, a 17% decrease to the technical component.  An example of the proposed 2017 fee schedule for pathology services is shown in the below table:

As protocol, when the final ruling is published, APS will be loading the 2017 fee schedule into our Contract Management program to make sure that the respective CPT codes will be reimbursed correctly.  In addition, any commercial carrier contracts that are tied to a percentage of the current year Medicare physician fee schedule will be updated to also monitor the reimbursement rates.