Medicare taking comments on 2021 physician payment proposals

The Centers for Medicare & Medicaid Services (CMS) is soliciting public comments on proposed changes to the Medicare Physician Fee Schedule (PFS) and other Medicare Part B issues. The changes are slated to take effect Jan. 1, 2021. Comments are due by Oct. 5 and can be submitted at http://www.regulations.gov.

The changes are a mix of good news and bad news for family physicians, but taken as a whole CMS estimates they will result in a 13% increase in family physicians’ Medicare allowed charges in 2021.

First, the good news. As decreed in the 2020 PFS final rule, CMS will be largely aligning its evaluation and management (E/M) visit coding and documentation policies in 2021 with changes laid out by the CPT Editorial Panel. Those changes will allow physicians to select the level of code using either total time or level of medical decision-making. CMS only proposes to clarify the times for which prolonged office/outpatient E/M visits can be reported and to revise the times used for rate setting.

CMS also proposes to follow through with plans to increase the relative value units (RVUs) for office/outpatient E/M visits in 2021. Commensurate with that increase, CMS proposes to revalue the following code sets that include, rely upon, or are analogous to office/outpatient E/M visits:

• End-Stage Renal Disease (ESRD) Monthly Capitation Payment (MCP) Services,
• Transitional Care Management (TCM) Services,
• Maternity Services,
• Cognitive Impairment Assessment and Care Planning,
• Initial Preventive Physical Examination (IPPE) and Initial and Subsequent Annual Wellness (AWV) Visits,
• Emergency Department Visits,
• Therapy Evaluations,
• Psychiatric Diagnostic Evaluations and Psychotherapy Services.

Now, the bad news. CMS has proposed a 2021 PFS conversion factor of $32.26, which is a decrease of $3.83 from this year. CMS attributes this drop to the budget neutrality adjustment it’s legally required to make to account for the increase in RVUs. Leaders of the American Medical Association said Aug. 4 they will push for Congress to waive the budget neutrality rule in light of the financial struggles COVID-19 has imposed on physicians. But as it stands, the proposed rule includes this decrease.

CMS also proposes to:

• Expand the services on the Medicare telehealth list,
• Reduce the frequency limit on subsequent nursing facility visits provided via telehealth from once every 30 days to once every three days,
• Clarify payment policy related to remote physiologic monitoring services,
• Establish new payment rates for immunization administration services, so Medicare payments better reflect the resources required.

For a condensed version of the proposed rule, see this CMS fact sheet. A related press release is also available. The American Academy of Family Physicians (AAFP) has also released its own summary.

— Kent Moore, Senior Strategist for Physician Payment at the AAFP