Medicare PPS Base Rate for 2016

As a reminder, on January 1, 2016, Medicare increased the Prospective Payment System (PPS) base payment rate from $158.85 to $160.60. The PPS base payment rate is effective for the calendar year 2016 and reflects a 1.1% increase from the calendar year 2015 rate. The rate was updated to reflect inflation, and the increase is in accordance with the growth rate of the Medicare Economic Index (MEI).
The geographic adjustment factor (GAF) rate schedule used to calculate the individual’s Federally Qualified Health Center (FQHC) PPS rate has also been updated based on the geographic practice cost indices (GPCIs) used to adjust payment under the Medicare Physician Fee Schedule (MPFS). The FQHC GAF is adapted from the work and practice expense GPCIs which are updated when the work and practice expense GPCIs are updated for the MPFS.
Effective January 1, 2016, the following changes have also taken place:

• Advanced Care Planning (ACP) (CPT code #99497) will be a stand-alone billable visit.
• A counseling visit to discuss the need for lung cancer screening (ldct) using low dose ct scan (CPT code G0296) is a billable visit under Medicare reimbursement G-codes G0466 and G0467.
• FQHCs may receive an additional payment for the cost of chronic care management (CCM) services (CPT code #99490) provided to Medicare beneficiaries when all CCM requirements are met.

AAFCPAs encourages FQHCs to revisit the individual PPS rate previously calculated to ensure that it reflects the 2016 updates.
AAFCPAs has been helping healthcare entities succeed since our founding in 1973. If you have any questions, please contact your AAFCPA partner, or Matt Hutt at 774.512.4043, mhutt@aafcpa.com.