Rural Zip Code Designations for National Pricing Released by CMS

COLUMBIA, S.C. (October 6, 2015)—Providers have been anxious to see the final rates for the national pricing rollout scheduled to begin January 1, 2016. CMS posted the first of the preliminary files today, but still no final rates yet (October 6th).

CMS officially released the listing of rural zip codes (here). Rural areas will be subject to a slightly higher reimbursement rate than their urban counterparts. The file consists of 5,000 zip codes across 45 states that are to be designated as rural areas.

Beyond the listing of zip codes, CMS also released a file that will be the bones for the formal posting of the new fee schedules for non-rural and rural areas by state (here). However, note that today’s release is only to exhibit the format changes and does not contain actual pricing data. We do expect that information to be published in the coming days.

Because CMS is phasing in the price reductions, suppliers will see a higher fee schedule amount from January 1, 2016 to June 30, 2016. That fee schedule amount will be derived from 50 percent of the current fee schedule plus 50 percent of the final national rates determined by CMS. On July 1, 2016, the rates will drop again to fully implement the official national pricing derived from competitive bid rates.

If you are looking for additional background information on the changes, CMS previously posted a FAQ regarding the pending pricing changes here.