Medicare Conversion Factor Chart

2016 February Update. With the “Doc Fix” last April, here is what Congress did to the “fiscal cliff.”

They flatlined it. No growth, no increases for health professionals, regardless of increases in the costs of providing services, and increased demands and needs for services by our seniors.


Here is what the “Fiscal Cliff” means to doctors and the patients we take care of who have Medicare.

If the rates just announced by Medicare go into effect as of Jan. 1, 2013, the main factor used to calculate rates for all Medicare services will decrease by 27% from 2012.

Imagine you are trying to project your business plan for the next year, and that the income you receive may decrease by 27% beginning less than two months from right now. Your costs are bound to continue to rise by at least the rate of inflation. What do you tell your employees? What do you tell your customers who use this method of payment for your services?

Imagine whether or not this happens depends on a lame duck Congress.

Here is the cliff we almost went over this year. Congress has done this year in and year out, for many years now (14 times since 2001). There has been a chronic failure to face the real challenges, and make the difficult decisions.  The following graph shows the value required by law without the 2 month extension signed into law 12/23/2011. If that conversion factor ($24.67) had gone into effect 3/1/2012, it would have caused a 27.39% reduction from 2011, which was 20.4% below the 1992 rate. Try running a business with numbers like these. Try providing any service with numbers like these.

© 2011 Gordon I. Herz, PhD. All Rights Reserved.

Note: From 1993 to 1997, there were separate conversion factors for surgical, nonsurgical (in 1993), primary care and “other non-surgical” procedures. For those years, the conversion factor for ‘nonsurgical’ or ‘other nonsurgical’ procedures is shown.


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