CMS Releases CY 2017 HOPPS & MPFS Final Rules - Effective January 1, 2017

November 3, 2016

On Tuesday, November 2, the Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2017 Final Rule for the Hospital Outpatient Prospective Payment System (OPPS). On Wednesday, November 3, CMS released the CY 2017 Final Rule for the Medicare Physician Fee Schedule (MPFS). Both rules have a 60-day public comment period. SNMMI has prepared payment rate charts for both rules (see below) and will submit comments by the end of the comment period. 

Hospital Outpatient Prospective Payment System

The OPPS rule updates Medicare payment policies and rates for hospital outpatient department and ambulatory surgical center services. In the CY 2017 final rule, CMS finalized several items, including a restructure of the imaging ambulatory payment classifications (APCs), an expansion of its use of comprehensive APCs (C-APCs), a new modifier for reduction in film-based X-ray services and expanded definition of the applicable codes, and some less restrictive implementation of Section 603B to impose site-neutral payments for off-campus sites.

View the 2017 FINAL compared to 2016 October FINAL Hospital Rate APC Chart

The CMS fact sheet on the OPPS Final Rule can be accessed here.

Medicare Physician Fee Schedule

The MPFS rule pays for covered physicians’ services furnished to a person with Medicare Part B. CMS applied the 0.5% payment increase required by the Medicare Access and CHIP Reauthorization Act of 2015, and mandated budget neutrality cuts which will increase physician payment rates by 0.24% for 2017 compared to 2016. CMS also included changes to the quality measurement requirements of the Medicare Shared Savings Program, including revisions to the measure set and quality data validation process, a change to allow individual eligible professionals participating in MSSP to report quality data separately for the purposes of the Physician Quality Reporting System, and to have that data used in PQRS in the event the MSSP Accountable Care Organization fails to report quality data. CMS also included updates to the informal review process used in the physician value modifier program.

View the 2017 FINAL compared to 2016 October FINAL Medicare Physician Fee Schedule Chart 

CMS fact sheet on the MPFS Final Rule can be accessed here.