In an effort to control the rapidly growing Medicare expenditures for outpatient services and the large co-payments being made by Medicare beneficiaries, the Centers for Medicare and Medicaid Services (CMS) created the Hospital Outpatient Prospective Payment System (HOPPS). This payment system provides a fixed, prospectively determined, bundled payment for hospital-provided outpatient products and services, excluding services of physicians and other health care providers.

For the same reason, CMS developed the Medicare Physician Fee Schedule (MPFS) to reimburse physician services. The MPFS is funded by Part B and is composed of costs associated with physician work, practice expense and professional liability insurance.

On October 30, 2015, CMS released the Medicare Physician Fee Schedule Final Rule for CY2016 and the Hospital Outpatient Prospective Payment Systems. Overall, there is no change in the estimated combined impact on total allowed charges for cardiology from 2015 to 2016. However, you should note that CMS finalized its proposal in the HOPPS rule to restructure the nuclear medicine APCs and added an additional APC (5594: Nuclear Medicine and Related Services) which will be composed of PET imaging.

For further details see the charts below:

CY2016 Medicare Physician Fee Schedule Payment Chart

CY2016 Hospital Outpatient Prospective Payment System Chart