The Centers for Medicare & Medicaid Services (CMS) finalized the Medicare physician fee schedule for 2013. Unless Congress intervenes, the rule implements a 26.5 percent reduction in Medicare physician payments in 2013 based on the sustainable growth rate (SGR) formula. MGMA will continue its steadfast advocacy efforts to repeal the flawed SGR formula, and we encourage you to reach out to your lawmakers on this critical issue, and MGMA has released the following summary:

The final rule:

  • Sets payment rates for CY 2013 for physician services based on a $25.0008 conversion factor
  • Adopts an MGMA recommendation to initially apply the value based payment modifier (VBPM) only to groups of 100 or more eligible professionals (EPs) (rather than to groups of 25+ EPs as earlier proposed)
  • Finalizes changes to the Physician Quality Reporting System (PQRS) and Electronic Prescribing (e-prescribing) Incentive Programs, including new e-prescribing hardship exemptions for those participating in the Meaningful Use EHR Incentive Program
  • Adopts a Multiple Procedure Payment Reduction (MPPR) to the TC of certain second and subsequent diagnostic cardiovascular and diagnostic ophthalmology services, furnished by the same physician (or physicians in the same group practice) to the same beneficiary, on the same day
  • Finalizes, with modification, a new transitional care management code to pay for coordinating a patient’s care in the 30 days following a hospital or skilled nursing facility stay

CMS released additional information on its web site. MGMA will analyze this final rule and provide a detailed analysis as a member benefit. For the latest news regarding Medicare physician payment, visit