Final physician fee schedule: Payment, policy, coding changes in final 2019 Medicare physician fee schedule

Why This Topic Matters

The final physician fee schedule drives Medicare payment and reporting requirements across a wide range of outpatient settings. Understanding the changes helps practices prepare for upcoming compliance, documentation, and reimbursement impacts.

Article Sections

1. Payment changes

   Summarizes Medicare payment updates affecting physician services, anesthesia services, drug payment policy, and certain provider-based outpatient department rates.

2. Policy changes

   Reviews CMS policy updates for telehealth, originating sites, rural and federally qualified health centers, care management, therapy reporting, geographic practice cost indices, advanced imaging, and Medicaid interoperability.

3. New telehealth services

   Covers additions to the telehealth benefit and the general setting requirements tied to those services.

4. Telehealth originating site expansions

   Describes changes to originating site eligibility and the timing of those changes for certain patient situations.

5. Originating site fee update for telehealth services

   Notes the annual update to the telehealth originating site fee.

6. Radiology assistants: “Direct” will do

   Explains CMS guidance affecting supervision expectations for radiology assistants performing diagnostic imaging procedures.

7. New virtual communication code launches for rural health centers (RHCs) and federally qualified health centers (FQHCs)

   Addresses virtual communication reporting for RHCs and FQHCs and how the new reporting framework relates to outpatient communication-based services.

8. Physician-directed care management enters equation in RHCs and FQHCs

   Summarizes care management payment methodology changes affecting RHCs and FQHCs.

9. Therapists see the end of functional status G-code reporting but the start of new modifiers for physical therapy assistants (PTAs) and occupational therapy assistants (OTAs)

   Covers the end of a therapy reporting requirement and the introduction of assistant-related modifiers for certain therapy services.

10. Watch for geographic practice cost index (GPCI) changes in 2020

    Discusses potential future updates to the practice expense geographic methodology and a related payment floor issue.

11. Appropriate Use Criteria (AUC) on for 2020

    Reviews the upcoming advanced imaging AUC program and CMS changes to participating settings, consultation requirements, hardship pathways, and future program development.

12. Medicaid Promoting Interoperability choices narrowed

    Summarizes Medicaid electronic quality reporting alignment with broader interoperability and quality reporting programs.