Five changes that will affect physician payment and productivity in 2020 and beyond

As usual, the new year brings changes in how doctors code and get paid for the services they provide to Medicare patients, as described in the Medicare physician fee schedule update. There are a host of things family physicians should know for 2020, as well as some changes to look forward to in 2021. Here are a few highlights:

1. New CPT codes for exchanging messages with patients through a secure online platform, such as an electronic health record portal, which allow time-based reporting of online digital E/M services,

2. New CPT codes for reporting services to develop and support blood pressure treatment plans in which patients measure readings themselves,

3. A new HCPCS code specifically for Medicare that will cover additional 20-minute periods of chronic care management services beyond the initial 20 minutes,

4. Increased payment for transitional care management services and an expansion of the list of services that can be reported concurrently, to include prolonged services, chronic care management services, and others,

5. In 2021: Revised office/outpatient visit codes that will permit physicians to choose the level of service based on either medical decision making or time (not just face-to-face time) alone; an increase in the relative value of these services; and an add-on code for visit complexity that can be used with most primary care visits.

The new Medicare physician fee schedule rule also includes some updates to the Quality Payment Program, the incentive payment program enacted in 2015 with the passage of the Medicare Access and CHIP Reauthorization Act, or MACRA, to replace the sustainable growth rate method of determining updates to the fee schedule. But unlike past years, the Centers for Medicare & Medicaid Services chose to keep many QPP requirements stable from 2019 to 2020.

To learn more about all of the changes, read the full FPM article, available online ahead of print: “The 2020 Medicare Documentation, Coding, and Payment Update.”