Medicare Payments

According to the 2015 Medicare Physician Fee Schedule final rule, neurologists can be reimbursed for the care coordination they provide for chronic conditions starting in 2015.

Total Medicare allowed charges for neurology are slated to be neutral in 2015.

2015 Physician Fee Schedule
AAN Takes a Stand on SGR Repeal Proposal

The recent Medicare Sustainable Growth Rate (SGR) fix postponed a 24.1-percent cut in Medicare physician payments for the next year. This means that the 0.5-percent increase that has been in effect since the start of the year will remain in place though the end of 2014. However, beginning January 1, 2015, payment rates will be frozen at the 2014 rates until the fix expires on March 31, 2015.

Other provisions of the agreement to temporally fix SGR include:

  • A 12-month extension of the geographic adjustment (GPCI) "floor" of 1.0 for physician work in the Medicare fee schedule
  • Delay of the implementation of the ICD-10 diagnosis coding set until October 1, 2015
  • The Secretary of Health and Human Services would have discretion to continue suspending RAC post-payment audits under the "Two-midnight" policy through March 2015
  • Revises the laboratory fee schedule based on market-based private sector rates
  • Adjusts payments for CT equipment that does not meet certain dosage standards and implements appropriate use criteria for advanced imaging services
  • In 2024, adjustments to sequestration's physician cut would increase to 4 percent for the first six months, followed by zero percent for the second six months; this is done to amplify the impact of the cut and generate more savings
  • Read Capitol Hill Report: Special Edition

Medicare fee for service claims with dates of service or dates of discharge on or after April 1, 2013, will incur a two-percent reduction in Medicare payment.

Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME Competitive Bidding Program, will be reduced by two percent based upon whether the date of service, or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013.

Beneficiary payments for deductibles and coinsurance are not subject to the two percent payment reduction BUT Medicare's payment to beneficiaries for unassigned claims is subject to the cut.

The sequestration, resulting from the Budget Control Act of 2011, was postponed by the American Tax Payer Relief Act of 2012. The two percent Medicare cut is part of broader cuts, including automatic spending cuts to national defense and other non-defense budget, to eliminate a total of $1.2 trillion from the federal budget over the next decade.

Read the FAQ on Sequestration from the American Medical Association.

Release of Physician Payment Data

In April 2014, CMS published physician-identifiable data about services provided to FFS Medicare Part B beneficiaries.The New York Times and the Wall Street Journal published search tools. Now, anyone can search the data file to see the amounts paid to each Medicare provider.


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