The 2020 Medicare Documentation, Coding, and Payment Update

 

The Centers for Medicare & Medicaid Services is trying to make Medicare documentation less burdensome and planning more changes that should result in a pay raise for family physicians in the future.

Fam Pract Manag. 2020 Jan-Feb;27(1):8-13.

Author disclosures: no relevant financial affiliations disclosed.

As usual, the new year brings changes in how doctors bill and get paid for the services they provide to Medicare patients. The reforms that will most affect family physicians’ pay aren’t coming until 2021, when several changes in evaluation and management (E/M) coding and payment are projected to result in a 12% increase for family medicine.1 But there are still a host of things family physicians should know for 2020, including new codes to help you get paid for interacting with patients via the internet and new codes that should help make chronic care management (CCM) more financially rewarding. The Centers for Medicare & Medicaid Services (CMS) is also continuing its quest to streamline documentation requirements and develop new payment models intended to reward quality instead of volume. This article summarizes the 2020 changes most relevant to family medicine. As always, private payers’ policies may differ, so consult with your billing staff to understand any important differences.

KEY POINTS

  • Evaluation and management (E/M) changes projected to raise family medicine payments by 12% are coming in 2021. The 2020 Medicare physician fee schedule update includes a variety of E/M and other changes that took effect Jan. 1.

  • There are new CPT codes for exchanging messages with patients through a secure online platform such as an electronic health record portal; developing and supporting blood pressure treatment plans in which patients measure readings themselves; and providing chronic care management services beyond the initial 20 minutes.

  • The list of services that can be reported concurrently with transitional care management has been expanded.

CURRENT PROCEDURAL TERMINOLOGY (CPT) CHANGES

This year’s CPT changes relate to some of the services family physicians provide most often.

Evaluation and management (E/M). Some of the biggest changes to E/M coding aren’t coming until 2021, when a revision of the office/outpatient visit codes will permit physicians to choose the level of service based on either medical decision making or time (not just face-to-face time) alone. Concurrent with those changes, CMS plans to increase the relative value of those services under the Medicare physician fee schedule and create an add-on code for visit complexity that can be used with most primary care visits. Look for more information on these changes in future issues of FPM.

For 2020, the office/outpatient visit E/M codes will remain the same. But there are other E/M changes in effect this year, including codes for exchanging messages with patients through a secure online platform, such as an electronic health record portal. CPT code 99444 has been deleted and replaced with codes 99421–99423, which

ABOUT THE AUTHORS

Kent Moore is senior strategist for physician payment, Dr. Mullins is medical director for quality and science, and Erin Solis is manager of practice and payment for the American Academy of Family Physicians in Leawood, Kan.

Cindy Hughes is an independent consulting editor based in El Dorado, Kan., and a contributing editor to FPM.

Author disclosures: no relevant financial affiliations disclosed.

Reference

1. American Academy of Family Physicians Summary of the 2020 Final Medicare Physician Fee Schedule. https://www.aafp.org/dam/AAFP/documents/advocacy/payment/medicare/feesched/ES-2020FinalMPFS-110219.pdf. Accessed Dec. 6, 2019.

 
 

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