HIDA Government Affairs Alert


November 7, 2014


HIDA Releases Summary of Final Rules for CY 2015 Physician and Lab and

Key Changes to Open Payments Program


At the end of last week, the Center for Medicare & Medicaid Services (CMS) released its final rule on the CY 2015 Physician and Lab Medicare Fee Schedules. The rule also finalizes several changes to the reporting requirements under CMS’ Open Payments Program (i.e., the Physician Payments Sunshine Act) impacting distributors effective January 1, 2016.


HIDA has released its summary on the final rules for Physician and Lab Medicare Fee Schedule.


Key highlights from HIDA's summary include:

  • 0% increase for the first three months of CY 2015, then a 20.9% decrease in reimbursement starting April 1, 2014 under PFS
  • Increase in payments to primary care and decrease in radiation therapy centers and radiation oncology payments
  • -4.0% VBPM  maximum downward adjustment for physician groups of 10 or more in CY 2017
  • -2.0% VBPM  maximum downward adjustment for physician groups with 2 to 9 EPs in CY 2017
  • New $40.39 payment rate for a one per month per patient Chronic Care Management (CCM) cod
  • Adds 20 new individual measures and two new measure groups, totaling 255 overall measures
  • Eligible professionals (EPs) must now report nine measures from at least three of the national quality domains through PQRS
  • Adds four services to telehealth services for reimbursement
  • Increase of 3% in lab reimbursement
  • Delay of CLFS price rebasing until 2017
  • Extend the rebasing period to six years instead of five

Key highlights to the reporting requirements under CMS’ Open Payments Program include:

  • Requires applicable manufacturers and distributors that “hold title” to covered products to report the marketed name of covered devices and medical supplies related to each payment. Applicable manufacturers do not have to report the marketed name of non-covered devices and medical supplies relating to payments
    • HIDA submitted comments in opposition of the proposed change stating that requiring applicable manufacturers and distributors to report the marketed name of a device would diminish transparency and confuse the public. The marketed name of a device would not provide consumers with understandable and actionable information as the law intended.
  • Requires applicable manufacturers to indicate if the drug, device, biological or medical supply is covered or non-covered relating to each payment
  • Requires applicable manufacturers to report if the payment is unrelated to any covered or non-covered drug, device, biological or medical supply
  • Requires applicable manufacturers to report stocks, stock options or any other ownership interest as distinct categories
  • Deletes the continuing education exclusion in its entirety

Please contact HIDA Government Affairs if you have any questions, hidagovaffairs@hida.org or (703) 549-4432.