CMS Value Based Payment Modifier

CMS Value Based Payment Modifier now applies to Solo-Practitioners and All Physician Groups with 2+ Eligible Professionals

The CMS Value Based Payment Modifier (VBP) assess both quality of care furnished and the cost of care under the Medicare Physician Fee Schedule.  Implementation is based on participation in Physician Quality Reporting System (PQRS) and includes a payment adjustment based on PQRS reporting.  The VBP program is a part of CMS’ plan to improve quality and efficiency by applying comparative performance data.  Previously VBP was limited to groups of 10+ providers.  However,  based on 2015 reporting year, all physicians in groups with 2+ eligible professionals and physicians who are solo-practitioners, will be included in the CMS Value Based Payment Modifier for payment year 2017.

Based on 2015 performance and group size, payment adjustments may be made.  Below is a CMS slide from the 12/02/13 CMS presentation, which can be found at here.

CMS Value Based Payment Modifier

Successful PQRS reporting for 2015 is crucial to potentially avoid both the -2% PQRS penalty and the possible automatic -2% to -4% CMS VBP payment adjustment for non-PQRS reporters.  Those EPs who do not successfully report PQRS in 2015 will receive these two negative payment adjustments in 2017.  It is advisable to establish a plan for PQRS reporting in early 2015.  First determine eligibility  and select 2015 PQRS measure codes then implement a plan for successful reporting.


For more information please visit:

2015 Physician Value-based Payment Modifier Policies

2015 Medicare Physician Fee Schedule

2015 PQRS List of Eligible Professionals