PHYSICIAN FEE SCHEDULE FOR CALENDAR YEAR 2021

CMS has released proposed policy changes to the Medicare physician fee schedule for calendar year 2020 on August 3, 2020 at midnight (https://s3.amazonaws.com/public-inspection.federalregister.gov/2020-17127.pdf). CMS claims that the calender year 2021 PFS proposed rule is one of several proposed rules that reflect a broader administration - wide strategy to create a health care system that results in better accessibility, quality, affordability, empowerment, and innovation.

 

For interventional pain management programs for interventional pain management physicians, an overall picture shows that there is a 7% combined impact in reference to the charges by specialty, while many of the other specialties have shown decreases. A few specialties like endocrinology, family practices, general practices, and internal medicine have shown increases.

 

Consequently, multiple surgical specialists are extremely upset about this payment rule; however, for interventional pain physicians, it has not been that bad.

 

ASIPP has calculated the proposed preliminary physician payment rates compared to 2020.

 

Overall physician payment rates have shown declines, specifically, more commonly utilized procedures when performed in a facility setting, meaning ASC or hospital. The cuts are much less when performed in an office setting (non-facility setting). The schedule shows these payments:  http://www.asipp.org/Fee%20Schedules/2021PhyPro.pdf

 

Physician payment rule specifically deals with payment updates with reduction in the conversion factor for 2021 of $32.26, down from $36.09 in 2020.

 

The major reductions are based on the reconfiguration of CPT codes for evaluation and management services with increased payments, but based on time rather than components. The average increase in work RVU values is 8% or 0.17 work RVUs, for new patient codes and 28% or 0.33 work RVUs, for established patient visit codes.

 

https://www.cms.gov/newsroom/fact-sheets/proposed-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-4

 

CMS is required to keep the PFS budget neutral, which means that increasing the work RVU values for these 9 codes would require CMS to decrease work RVU values for other CPT codes, reduce the conversion factor, or some combination of both.

 

CMS announced in the calendar year 2020 Medicare Physician Fee Schedule (PFS) final rule that it would implement changes to office visit Evaluation and Management codes for the 2021 calendar year.

 

The expected 2021 PFS changes include documentation and code selection updates and updates to work RVU (wRVU) values. This alert will focus on the wRVU value updates that affect code ranges 99201 to 99205 (new patient visit codes) and 99211 to 99215 (established patient visit codes).

 

2.1   Evaluation and Management Services

 

CMS announced its plan to remove code 99201 from the new patient visit code range increase the wRVU values for the remaining new patient and established patient visit codes as outlined in the tables below:

 

2021 Physician Proposed Payment Rates for E/M Services

CPT

Description'

Non-Facility

(office)

Facility

(ASC/HOPD)

99201

Office/outpatient visit new

Deleted

Deleted

99202

New Patient Office Visit

$69.04

$46.13

99203

New Patient Office Visit

$106.14

$78.07

99204

New Patient Office Visit

$159.37

$127.75

99205

New Patient Office Visit

$210.66

$173.88

99211

Office/outpatient established patient

$22.26

$8.71

99212

Office/outpatient established patient

$54.20

$34.20

99213

Office/outpatient established patient

$86.78

$63.23

99214

Office/outpatient established patient

$122.91

$93.23

99215

Office/outpatient established patient

$172.27

$137.75

99441

Phone e/m phys/qhp 5-10 min

$54.20

$34.20

99442

Phone e/m phys/qhp 11-20 min

$87.10

$63.55

99443

Phone e/m phys/qhp 21-30 min

$123.56

$93.88

 

 

The average increase in wRVU values is 8 percent, or 0.17 wRVUs, for new patient codes and 28 percent, or 0.33 wRVUs, for established patient visit codes.

 

CMS is required to keep the PFS budget neutral, which means that increasing the wRVU values for these nine codes would require CMS to decrease wRVU values for other CPT codes, reduce the conversion factor, or some combination of both.

 

2.2   Telehealth

 

CMS proposed several services to the Medicare telehealth services list during the public health emergency for the COVID-19 pandemic, including home visits for established patients and psychological and neuropsychological testing.

 

One of the expansions which ASIPP has worked tirelessly was telephone only. We are grateful to CMS that they retained not only the codes, but also the payment rates as if a patient was seen in the office.