Medicare Physician Fee Schedule

The Medicare Access and CHIP Reauthorization Act (MACRA) was signed in April 2015. This law:

  • Repeals the Sustainable Growth Rate (SGR) methodology for determining updates to the Medicare physician fee schedule.
  • Establishes annual positive or flat fee updates for 10 years and institutes a two-tracked fee update afterwards.
  • Establishes a Merit-based Incentive Payment System that consolidates existing Medicare fee-for-service physician incentive programs.
  • Establishes a pathway for physicians to participate in alternative payment models, including the patient-centered medical home.
  • Makes other changes to existing Medicare physician payment statutes.

On November 1, 2019, the Centers for Medicare & Medicaid Services (CMS) released a final rule and interim final rule on the 2020 Medicare Physician Fee Schedule (MPFS). This regulation also impacts the Quality Payment Program (QPP). CMS released a related fact sheet and press release.

The final 2019 MPFS conversion factor is $36.0391. Reflecting the same values estimated in the proposed rule, the final 2020 MPFS conversion factor will be $36.0896. Based on CMS’ final rule, there would be no change in total Medicare allowed charges for family medicine in 2020, but total allowed charges for family medicine would increase 12% in 2021.

The AAFP commented on the 2020 proposal in a September 18, 2019 letter(61 page PDF).

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