Part B Payment: New Codes Without Pay Attached, 0.5 Percent Pay Increase Come January

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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 summarizes major items in CMS’s proposed 2016 Medicare Physician Fee Schedule and explains why the proposal matters to Part B practices. It covers payment update news, proposed changes to incident-to billing requirements, new advance care planning services that were introduced without payment in an earlier year, and valuation adjustments affecting certain gastroenterology services. The piece is aimed at physicians, practice managers, and coders following Medicare reimbursement policy and rulemaking.

Why This Topic Matters

The proposal could affect how Part B services are billed and paid, which services are separately payable, and how certain specialties may be reimbursed under Medicare in 2016. It is relevant to practices that bill incident-to services, provide advance care planning, or perform endoscopic lower GI procedures.

Article Sections

  1. CMS 2016 Medicare Physician Fee Schedule proposal

    Introduces the proposed rule and the overall Medicare Part B payment context for 2016. Covers the rulemaking timeline and the general scope of the changes discussed in the article.

  2. Proposed changes to incident-to rules

    Describes proposed updates affecting incident-to billing under Medicare Part B. Explains the types of provider, supervision, and compliance issues addressed in the proposal.

  3. Advance care planning payment proposal

    Summarizes the proposal involving advance care planning services and the newly introduced payment status. Discusses the policy context for these services and the comment process.

  4. Potential gastroenterology payment impact

    Reviews proposed valuation changes affecting gastroenterology reimbursement and the specialty-level impact described in the article. Notes the broader context of misvalued codes and public comment activity.

What You Will Learn

  • How CMS’s proposed 2016 fee schedule could affect Part B payment.
  • What broad categories of incident-to billing policy changes are being considered.
  • How advance care planning is being addressed in the proposal.
  • Which specialty area is highlighted for possible reimbursement changes.
  • How the rulemaking and comment process fits into Medicare payment updates.

Who Should Read This

  • Physicians
  • Practice managers
  • Medical coders
  • Billing staff
  • Gastroenterology practices
  • Medicare reimbursement professionals

Codes Discussed

  • CPT: 99497
  • CPT: 99498
  • CPT: 45380

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