American Urological Association - CMS Releases Proposed 2019 Medicare Physician Fee Schedule Rule

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Home Advocacy Advocacy by Topic Physician Payment and Coverage Issues CMS Releases Proposed 2019 Medicare Physician Fee Schedule Rule

CMS Releases Proposed 2019 Medicare Physician Fee Schedule Rule

Following the release of the 2019 Medicare Physician Fee Schedule and Quality Payment Program proposed rule on July 12, the AUA developed an easy reference on how the proposed rule could affect urology offices.

In addition, we have developed an impact table (see below) to identify some of the most common urology procedures in the office and facility setting. The table will display the difference in payment from 2018 to 2019 proposed values in RVUs for physician work, practice expense and malpractice. For changes to other urology codes, Addendum B Relative Value Units of the Proposed Rule (included in the CY 2019 PFS Proposed Rule Addenda) will identify the new proposed 2019 values for all CPT codes. The AUA continues to identify areas of concern for urology within the proposed rule, including:

  • Proposals Regarding E&M Visits;
  • Telehealth Services (and "Communication-Based Technology Services;")
  • Valuation of Specific Urology Codes;
  • Part B drugs;
  • the Quality Payment Program

The AUA will monitor the changes and report important issues in the near future. View the full 2019 Medicare Physician Fee Schedule and Quality Payment Program proposed rule and related fact sheets on how the proposal impacts the QPP and PFS. The Centers for Medicare & Medicaid Services (CMS) is accepting comments on the proposed rule through September 10, 2018. The final rule is expected to be released in early November. Any organization, individual physician or citizen can comment on the Medicare Physician Fee Schedule. In commenting, please refer to file code CMS-1693-P.

How to Comment

Comments, including mass comment submissions, must be submitted in one of the following three ways (please choose only one of the ways listed):

  1. Submit electronic comments on this regulation to http://www.regulations.gov. Follow the "Submit a comment" instructions.  
  2. Mail written comments to the following address ONLY:

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-1693-P
P.O. Box 8016
Baltimore, MD 21244-8016.

Please allow sufficient time for mailed comments to be received before the close of the comment period.

3. By express or overnight mail, send written comments to the following address ONLY: Centers for Medicare & Medicaid Services

Department of Health and Human Services,
Attention: CMS-1693-P
Mail Stop C4-26-05
7500 Security Boulevard
Baltimore, MD 21244-1850  

The charts below show the effect of the 2019 Medicare Physician Fee Schedule on some of the most utilized CPT codes by urologists in the facility and non-facility setting.

Facility Non-Facility
2019 MPFS Final Rule Conversion Tables Facility 2019 MPFS Final Rule Conversion Tables Non-Facility

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