The final rule updating the 2020 Medicare physician fee schedule has been released by The Centers for Medicare and Medicaid Services (CMS), updating and revising outpatient evaluation and management, the quality payment program and geographic payment adjustments. 

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To ensure that physicians treating the sickest patients are not unfairly penalized, CMS will implement coding and payment modifications in 2021 that are based on the resources required to perform various levels of office visits, while providing simpler solutions to coding and documentation.

CPT guidelines and recommendations proposed by the American Medical Association (AMA)-convened workgroup were accepted by CMS and will retain five levels of coding for established patients, reduce the number of levels to four for new patients and revise the code definitions.

However, some aspects of the final rule will depart from AMA’s recommendations and has omitted the global surgical codes in the new E/M coding system.

Additionally, CMS has increased data completeness requirements from 60% to 70%, requiring physicians to report on quality measures for at least 70% of their patients. 

CMS did, however, agree with recommendations from CMA, AMA and others in organized medicine to not increase the weight of the physician expenditure “cost category” due to a lack of sufficient feedback for physicians so they can understand how they are evaluated on costs.

More importantly, CMS reduced the impact of costs beyond a physician’s control by revising the Total Per Capita Cost and Medicare Spending Per Beneficiary methods and eliminated costs that were erroneously attributed to physicians. The new formula will also exclude physicians in specialties unlikely to be providing primary care to a patient. These are small but important wins for physicians.

The 2020 Medicare Physician Fee Schedule will implement the final phase of the California geographic payment fix, which is transitioning California payment localities to Metropolitan Statistical Areas. CMA will analyze the GPCI changes and issue more details once the analysis is finished.

Additional highlights from the final rule include:

  • Telehealth: There are several new Telehealth G codes eligible for payment.

  • Medication Assisted Treatments for Opioid Use Disorders: Last year, federal legislation authorized Medicare payment for certain opioid use disorder treatment and medication assisted treatments. Those new payment rates and services are outlined in the proposed rule, including bundled payments.

  • Care Management: CMS finalized its policy to increase payment for Transitional Care Management.

Read AMA’s summary of the final rule Here

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