Concerns that the codes used to determine payment for home dialysis patients would be revised were alleviated when the Centers for Medicare & Medicaid Services released the 2018 Medicare Physician Fee Schedule on July 13.

While CMS reaffirmed its position in the proposed rule that the home dialysis codes are misvalued, plans for a large-scale revaluation of those codes was not indicated.

In general, nephrology has a 0% impact for 2018 payments based on the proposed rule; the relative value units (RVUs) for all of the dialysis codes either hold steady or go up by a hundredth of an RVU point or two, according to a review by the Renal Physicians Association.

The conversion factor is increased from $35.88 to $35.99, resulting in a $1.23 increase in the adult in-center Monthly Capitated Payment for 2018. CMS also proposed a series of increases for the codes used to bill for apheresis.

Comments on the proposed rule can be made at and must be received by Sept. 11.

Similar to a request made by CMS when releasing the proposed rule covering the Prospective Payment System for dialysis clinics, the agency invited physicians “to start a national conversation about improving the health care delivery system; how Medicare can contribute to making the delivery system less bureaucratic and complex; and how we can reduce burden for clinicians, providers, and patients in a way that increases quality of care and decreases costs, thereby making the health care system more effective, simple, and accessible while maintaining program integrity and preventing fraud.”

Payment changes

Overall, the proposed rule offers the following changes to physician fees paid by Medicare:

  • The overall update to payments under the PFS based on the proposed CY 2018 rates would be +0.31%.
  • New codes for telehealth services are being proposed, including HCPCS code G0506 (Care Planning for Chronic Care Management) and CPT codes 90839 and 90840 (Psychotherapy for Crisis). CMS is also proposing to eliminate the required reporting of the telehealth modifier for professional claims in an effort to reduce administrative burden for practitioners. The agency said it is also seeking comment on ways to further expand access to telehealth services within its current statutory authority.