Medicare PPS Base Rate for 2016

As a reminder, on January 1, 2016, Medicare increased the Prospective Payment System (PPS) base payment rate from $158.85 to $160.60. The PPS base payment rate is effective for the calendar year 2016 and reflects a 1.1% increase from the calendar year 2015 rate. The rate was updated to reflect inflation, and the increase is in accordance with the growth rate of the Medicare Economic Index (MEI).
The geographic adjustment factor (GAF) rate schedule used to calculate the individual’s Federally Qualified Health Center (FQHC) PPS rate has also been updated based on the geographic practice cost indices (GPCIs) used to adjust payment under the Medicare Physician Fee Schedule (MPFS). The FQHC GAF is adapted from the work and practice expense GPCIs which are updated when the work and practice expense GPCIs are updated for the MPFS.
Effective January 1, 2016, the following changes have also taken place:

  • Advanced Care Planning (ACP) (CPT code #99497) will be a stand-alone billable visit.
  • A counseling visit to discuss the need for lung cancer screening (ldct) using low dose ct scan (CPT code G0296) is a billable visit under Medicare reimbursement G-codes G0466 and G0467.
  • FQHCs may receive an additional payment for the cost of chronic care management (CCM) services (CPT code #99490) provided to Medicare beneficiaries when all CCM requirements are met.

AAFCPAs encourages FQHCs to revisit the individual PPS rate previously calculated to ensure that it reflects the 2016 updates.
AAFCPAs has been helping healthcare entities succeed since our founding in 1973. If you have any questions, please contact your AAFCPA partner, or Matt Hutt at 774.512.4043,

About the Author

Matthew Hutt CPA
Matt leads AAFCPAs’ Healthcare Division, providing assurance, tax and advisory solutions for Federally Qualified Health Centers (FQHCs), behavioral health providers, home care agencies and hospices, nursing homes, and senior care living centers. Matt advises healthcare providers on consolidation and coordination of care, including the integration of behavioral health into the primary care delivery system. He also provides consulting solutions for providers transitioning to new value-based reimbursement models, and data driven patient care, including: developing business process and controls for collecting and advantaging data to provide analysis on: provider activity, delivery of care, and analysis of efficiency & cost effectiveness. Matt is also highly-sought after for his knowledge on issues related to affordable housing developers with requirements related to the US Department of Housing and Urban Development, MassHousing, Low Income Housing Tax Credits, Historical Tax Credits and New Markets Tax Credits. 

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