Earlier this week, the Center for Medicare and Medicare Services issued the final Medicare Physician Fees Schedule rule for 2021. As expected, the final rule included significant reimbursement increases for cognitive medicine. However, due to Congressional budget neutrality requirements, the E/M increases are offset by payment reductions in other services. Below is a quick summary of key parts of the final rule:
- Final CY 2021 PFS conversion factor is $32.41, a decrease of $3.68 from the CY 2020 PFS conversion factor of $36.09. The conversion factor decrease is driven by the need to offset the payment increases for office-base E/M services.
- Creation of new add on code - G2211 to capture complex care provided in office/outpatient E/M visits.
- Creation of new code G2212 to clarify the times for which prolonged office/outpatient E/M visits can be reported.
- Clarification of coverage for virtual services during the COVID Public Health Emergency
The ATS is still reviewing the final rule and will have more detailed information in the next issue of the ATS Coding and Billing Quarterly. Further, the ATS will hold a webinar in January 2021 to share with members further details on the CMS final rule and how physicians should incorporate the new codes into their billing patterns.
Below is a chart prepared by CMS that estimates the likely impact of the final payment rule on physicians by specialty.
| (A) Specialty |
(B) Allowed Charges (mil) | (C) Impact of Work RVU Changes | (D) Impact of PE RVU Changes | (E) Impact of MP RVU Changes | (F) Combined Impact |
|---|---|---|---|---|---|
| ALLERGY/IMMUNOLOGY | $247 | 5% | 4% | 0% | 9% |
| ANESTHESIOLOGY | $2,020 | -6% | -1% | 0% | -8% |
| AUDIOLOGIST | $75 | -4% | -2% | 0% | -6% |
| CARDIAC SURGERY | $266 | -5% | -2% | 0% | -8% |
| CARDIOLOGY | $6,871 | 1% | 0% | 0% | 1% |
| CHIROPRACTOR | $765 | -7% | -3% | 0% | -10% |
| CLINICAL PSYCHOLOGIST | $832 | 0% | 0% | 0% | 0% |
| CLINICAL SOCIAL WORKER | $857 | 0% | 1% | 0% | 1% |
| COLON AND RECTAL SRUGERY | $168 | -4% | -1% | 0% | -5% |
| CRITICAL CARE | $378 | -6% | -1% | 0% | -7% |
| DERMATOLOGY | $3,767 | -1% | 0% | 0% | -1% |
| DIAGNOSTIC TESTING FACILITY | $748 | -1% | -2% | 0% | -3% |
| EMERGENCY MEDICINE | $3,077 | -5% | -1% | 0% | -6% |
| ENDOCRINOLOGY | $508 | 10% | 5% | 1% | 16% |
| FAMILY PRACTICE | $6,020 | 8% | 4% | 0% | 13% |
| GASTROENTEROLOGY | $1,757 | -3% | -1% | 0% | -4% |
| GENERAL PRACTICE | $412 | 5% | 2% | 0% | 7% |
| GENERAL SURGERY | $2,057 | -4% | -2% | 0% | -6% |
| GERIATRICS | $192 | 1% | 1% | 0% | 3% |
| HAND SURGERY | $246 | -2% | -1% | 0% | -3% |
| HEMATOLOGY/ONCOLOGY | $1,707 | 8% | 5% | 1% | 14% |
| INDEPENDENT LABORATORY | $645 | -3% | -2% | 0% | -5% |
| INFECTIOUS DISEASE | $656 | -4% | -1% | 0% | -4% |
| INTERNAL MEDICINE | $10,730 | 2% | 1% | 0% | 4% |
| INTERVENTIONAL PAIN MGMT | $936 | 3% | 3% | 0% | 7% |
| INTERVENTIONAL RADIOLOGY | $499 | -3% | -5% | 0% | -8% |
| MULTISPECIALTY CLINIC/ OTHER PHYS | $153 | -3% | -1% | 0% | -3% |
| NEPHROLOGY | $2,225 | 4% | 2% | 0% | 6% |
| NEUROLOGY | $1,522 | 3% | 2% | 0% | 6% |
| NUEROSURGERY | $811 | -4% | -2% | -1% | -6% |
| NUCLEAR MEDICINE | $56 | -5% | -3% | 0% | -8% |
| NURSE ANES/ANES ASST | $1,321 | -9% | -1% | 0% | -10% |
| NURSE PRACTITIONER | $5,100 | 5% | 3% | 0% | 7% |
| OBSTETRICS/GYNECOLOGY | $636 | 4% | 3% | 0% | 7% |
| OPHTHALMOLOGY | $5,343 | -4% | -2% | 0% | -6% |
| OPTOMETRY | $1,359 | -2% | -2% | 0% | -4% |
| ORAL/MAXILLOFACIAL SURGERY | $79 | -2% | -2% | 0% | -4% |
| ORTHOPEDIC SURGERY | $3,812 | -3% | -1% | 0% | -4% |
| OTHER | $48 | -3% | -2% | 0% | -5% |
| OTOLARNGOLOGY | $1,271 | 4% | 3% | 0% | 7% |
| PATHOLOGY | $1,265 | -5% | -4% | 0% | -9% |
| PEDIATRICS | $67 | 4% | 2% | 0% | 6% |
| PHYSICAL MEDICINE | $1,164 | -3% | 0% | 0% | -3% |
| PHYSICAL/OCCUPATIONAL THERAPY | $4,973 | -4% | -4% | 0% | -9% |
| PHYSICIAN ASSISTANT | $2,901 | 5% | 2% | 0% | 8% |
| PLASTIC SURGERY | $382 | -4% | -3% | 0% | -7% |
| PODIATRY | $2,133 | -1% | 0% | 0% | -1% |
| PORTABLE X-RAY SUPPLIER | $95 | -2% | -4% | 0% | -6% |
| PSYCHIATRY | $1,112 | 4% | 3% | 0% | 7% |
| PULMONARY DISEASE | $1,654 | 0% | 0% | 0% | 1% |
| RADIATION ONCOLOGY AND RADIATION THERAPY CENTERS | $1,809 | -3% | -3% | 0% | -5% |
| RADIOLOGY | $5,275 | -6% | -4% | 0% | -10% |
| RHEUMATOLOGY | $548 | 10% | 5% | 1% | 15% |
| THORACIC SURGERY | $352 | -5% | -2% | 0% | -8% |
| UROLOGY | $1,810 | 4% | 4% | 0% | 8% |
| VASCULAR SURGERY | $1,293 | -2% | -4% | 0% | -6% |
| TOTAL | $97,008 | 0% | 0% | 0% | 0% |
*Column F may not equal the sum of columns C, D, and E due to rounding.
