2016 Health Care Services Rules and Fee Schedule Effective January 13, 2017

The 2016 Health Care Services Rules and Fee Schedule is effective as of January 13, 2017, and will replace the current 2015 fee schedule. The updated rules, manual, and fee schedule worksheets are posted, and are based on 2016 source documents such as the 2016 October release CMS Physicians Fee Schedule, as well as 2016 CPT® and HCPCS Level II procedure codes.  Some highlights of the updated rule language include:

  • Updated source documents

  • Revised rules regarding billing and reimbursement of drug testing, drug screening, and drug confirmation testing.

  • Revised rules regarding reimbursement for commercially manufactured topical medications, which are over-the-counter or contain over-the-counter ingredients.

  • Revised rules for anesthesia billing and reimbursement with the addition of modifier–AD.

  • Revised rules clarifying reimbursement for ASC facility charges pertaining to multiple procedures.

  • New definition of utilization review

Please feel free to contact the Agency with any questions or comments on our toll free line at 1-888-396-5041.