Medicare Physician Fee Schedule: Beware 2016 Fee Changes That Could Slash Your Pay

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article reviews 2016 Medicare Physician Fee Schedule changes that matter to general surgery practices, especially those performing gastrointestinal endoscopy. It covers the impact of misvalued code adjustments, CMS estimates tied to specialty payment changes, and how broader fee schedule updates affect payment methodology. The piece is relevant to surgeons, practice managers, and coding/billing professionals who need a high-level understanding of fee schedule revisions and their potential effect on reimbursement.

Why This Topic Matters

The article helps readers understand why fee schedule updates can change reimbursement patterns across a practice, not just for individual procedures. It is particularly important for groups with significant endoscopy volume or those tracking annual Medicare payment policy changes.

Article Sections

  1. Understand Misvalued Code Updates

    Introduces the Medicare policy background behind misvalued code adjustments and describes the broader fee schedule framework affecting payment updates. It also references the professional groups involved in reviewing affected services.

  2. Suck Up These Endoscopy Losses

    Focuses on the expected payment impact for gastrointestinal endoscopy services and discusses the specialty-level effects described in the rule. It highlights the area of the fee schedule most relevant to general surgery practices with endoscopy volume.

  3. Expect Conversion Factor Reduction

    Explains the Medicare conversion factor update and the other policy components that contribute to the overall yearly payment change. It places the final rule’s fee schedule update in the context of Medicare payment methodology.

What You Will Learn

  • How the 2016 Medicare Physician Fee Schedule final rule affects general surgery reimbursement
  • Why misvalued code updates matter for practices with endoscopy volume
  • How broader Medicare payment adjustments influence the conversion factor
  • What kinds of fee schedule changes can affect multiple services across a practice

Who Should Read This

  • General surgeons
  • Gastroenterology-related surgical practices
  • Medical coders
  • Billing staff
  • Practice managers
  • Reimbursement professionals

Code Ranges Discussed

  • CPT: 44385 TO 45398

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