2019 Physician Fee Schedule Proposed Rule Released: Impact On Interventional Pain Management

On July 12, 2018, the Centers for Medicare and Medicaid Services (CMS) published the proposed physician fee schedule rule for 2019. It also includes provisions for the Quality Payment Program (QPP) for 2019 with physician fee schedule. Major breakthroughs in this schedule are as follows:

1. Based on the budget neutrality adjustment to account for relative value changes, as required by law, the proposed 2019 fee-for-service (FFS) conversion factor is $36.05, a slight increase from $35.99 for 2018.

2. Change of payment modality for evaluation and management services similar to United Kingdom with one payment for most levels of services, avoiding the issues of upcoding, downcoding, etc

  • CMS has proposed to collapse payment for office and outpatient visits
  • New patient office visits (99202 - 99205) payments would be blended to be $135 instead of $76 for Level II to $172 to Level V.
  • For established patient office visits (99212 - 99215) would be blended to be paid at $93 instead of $45 for Level II and $148 for Level V.
  • CMS also will create new codes to provide add-on payments to office visits for specific specialties ($9) and for primary care physician ($5)

Click here for Payment for Office/Outpatient Based E/M Visits

3. For interventional techniques there have been some changes; however, majority of the changes seem to be minor and small except for increases for hip joint injection and significant decreases for some of the codes for electronic analysis of programmable pump, occipital nerve blocks, suprascapular nerve blocks, etc. There are also some increases for spinal cord neuro-electrode placement, specifically in an office setting with 19% increase. Please see the enclose fee schedule which compares rates from 2017, 2018, to 2019 proposed payment rates


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