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