HomeWashington Letter2021 ▶ Congress Makes Major Changes to the Medicare Physician Fee Schedule Rule
Congress Makes Major Changes to the Medicare Physician Fee Schedule Rule

The COVID-19 relief package also included significant Medicare payment relief for 2021. Below are the key policy items that are of interest to ATS members.

Conversion Factor – Congress took steps to address the steep cut in the 2020 Medicare conversion factor, including providing $3 billion in general funding, eliminating the new complex care code and delaying other budget requirements that lead to the CMS projected cut of -10.2 percent in the 2021 Medicare conversion factor. CMS still has to put out a revised conversion factor taking account all the Congressionally mandated changes – but it is expected the final 2021 conversion factor will be approximately $34.89, which is a -3.3 percent reduction from the 2020 conversion factor.

G2211 Implementation Delayed – Congress also mandated a 3-year delay in implementation of the new G2211 code (Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition. (Add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established). The three-year delay in G2211 implementation freed up additional Medicare funds to pay for the 2021 conversion factor changes.

E/M Outpatient Payment Increases – Congress did not take any action to delay or amend the CMS finalized increases in Medicare payments for outpatient visits. ATS members who frequently bill outpatient E/M visit should expect to see an increase in Medicare revenue as a result of these changes. 

Last Reviewed: January 2021