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2016 Medicare Part B Rates


On Nov. 16, 2015, the Centers for Medicare and Medicaid Services (CMS) released the Medicare Physician Fee Schedule (MPFS) final rule for calendar year (CY) 2016.  Officially titled: CY 2016 Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Medicare Part B (CMS-1631-P), the final rule covers Medicare Part B payment rates for physician and ancillary services provided by nursing homes and home health agencies.  LeadingAge national has updated its Part B Rate Calculation tool to reflect this final rule for rates effective Jan. 1, 2016.

To access the new rate tool you may click on the link above or log into the LeadingAge web site at www.leadingage.org and click on “Members”, then “Nursing Homes”, and then “Payment and Finance” where you will find a link to the Medicare Part B Therapy Rates for 2016.  If anyone has difficulty accessing the tool, please contact me for assistance.

Also, please remember that New York is divided into the following payment localities for MPFS rates:

Payment Locality:



New York

NYC Suburbs/Long Island

Bronx, Brooklyn, Kings, Nassau, Richmond, Rockland, Staten Island, Suffolk, Westchester

Poughkeepsie/NYC Suburbs

Columbia, Delaware, Dutchess, Greene, Orange, Putnam, Sullivan, Ulster



Rest of State

All Other Counties

You should be sure to select the correct locality on the drop down menu found on the rate calculation tool.

This is the first MPFS rule issued by CMS since the elimination of the sustainable growth rate (SGR) methodology.  LeadingAge NY has provided our members with extensive guidance on the so called “Doc Fix”, which along with elimination of the threat of large SGR-driven rate cuts also extends the therapy caps exceptions process.

Providers will find that there is only a modest technical adjustment in the conversion factor from the second half of 2015 to 2016, going from the current $35.9335 to $35.8278; therefore you should see only a minor adjustment in rates effective Jan. 1st.  In addition to policies affecting the calculation of payment rates, the final rule makes other technical adjustments to certain codes and adds procedures to the telehealth list.  New policies being finalized from the proposed rule include:

  • The Physician Quality Reporting System (PQRS);
  • The Physician Value-Based Payment Modifier (Value Modifier); and
  • The Medicare Electronic Health Record (EHR) Incentive Program.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827