When the Centers for Medicare and Medicaid Services (CMS) released the Final Rule of the Medicare Physician Fee Schedule recently, it contained two sets of conversion factors for calculating the 2015 fees: one for January through March 2015 and another for April through December.
The standard conversion factor for January through March 2015 is $35.8013. The anesthesia conversion factor for that period is $22.5550. The 2014 Protecting Access to Medicare Act (PAMA), which avoided drastic fee cuts per the flawed Sustainable Growth Rate, mandated that fees for the first quarter of 2015 remain the same as the rates set for April through December 2014. Additional mandates of budget neutrality forced the rate to be reduced by .06 percent.
Rates for April through December 2015, however, are calculated based on the Sustainable Growth Rate formula, and as mandated by PAMA, must be computed as if increases in previous years had not applied. Taking that into consideration, and also adding the budget neutrality adjustment and standard update factors, the standard conversion factor for April through December 2015 currently stands at $28.2239, a 21.2 percent decrease from 2014. For anesthesia, the conversion factor for that same time period is $17.7913, a 21.5 percent decrease from 2014.
| 2014 | January-March 2015 | April-December 2015 | |
| Standard Conversion Factor | $35.8228 | $35.8013 | $28.2239 |
| Anesthesia Conversion Factor | $22.6765 | $22.5550 | $17.7913 |
As in past years, industry experts expect Congress to act to avoid the drastic 21.2 percent Medicare fee cuts. Groups like the American Medical Association continue to lobby for a permanent solution to the flawed SGR, though no current action by Congress appears to be imminent. In the 2015 Final Rule, CMS has indicated its desire to see a permanent solution as well.
“While Congress has provided temporary relief from these reductions every year since 2003, a long-term solution is critical. We will continue to work with Congress to fix this untenable situation so doctors and beneficiaries no longer have to worry about the stability and adequacy of payments from Medicare under the PFS.”
CMS has released the 2015 fee schedule using only the first quarter conversion factors. You can find downloadable text files of that fee schedule by state, locality, and CPT/HCPCS on the Medicare website or on your Medicare Administrative Contractor website (click here for WPS Medicare). Information about the fee schedules for April and beyond will presumably be released closer to that time based on Congress’ intervention.
For more information, visit the Medicare Fee Schedule page.
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