2017 Medicare Physician Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) has released the Medicare rates for 2017 as well as a fact sheet summarizing the policy and payment changes that take effect January 1, 2017. The 2017 conversion factor will be $35.8887 – only a slight increase over the 2016 conversion factor of $35.8043. However, the 2017 rules contain several items of good news for allergists.

  • Increases for venom immunotherapy: Medicare payment for venom immunotherapy (CPT Codes 94145-95149) will increase between 17% and 40% to reflect increases in costs of venom. This is a direct result of the Advocacy Council’s efforts.
  • Increased payment for complex patients: Allergists may be paid more for dealing with complex patients that require substantial time and case management. Beginning in 2017, Medicare will:
    • Make separate payment for CPT Codes describing non-face-to-face prolonged evaluation and management services;
    • Increase payment for existing face-to-face prolonged evaluation and management services;
    • Pay separately for comprehensive assessment and care planning for patients with cognitive impairments such as dementia;
    • Pay separately for codes for chronic care management for patients with greater complexity;
  • Allergy immunotherapy payment maintained after revaluation: Allergy immunotherapy codes (CPT Codes 95144 and 95165) were on the Medicare list of potentially misvalued codes and underwent revaluation this year. Although this frequently results in reductions in payment, the Advocacy Council was successful in maintaining existing payment and was even able to obtain a 3% increase in recognition of increased practice expense costs. The 2017 national rate will be $13.28 per dose compared with $12.89 in 2016. Rates will, however, vary throughout the country due to geographic adjustments.
Advocacy Issue: 
Billing, Coding & Payments