Medicare Physician Fee Schedule

Medicare Physician Fee Schedule 2021 Final Rule Educational Session

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Medicare Physician Fee Schedule Overview

HSG’s Dr. Terry McWilliams has spent countless hours comprehensively reviewing the 2,000+ page 2021 Medicare Physician Fee Schedule Final Rule document released by CMS on December 1st 2020.

The recorded educational session and associated handouts are the result of Dr. McWilliam’s comprehensive review. We believe this to be the most robust source currently available outlining critically important areas that health systems must be prepared to address in 2021 as a result of the Final Rule.

Key 2021 Final Rule Topics Areas Addressed Through the Educational Session

  • Medicare Physician Fee Schedule Final Rule Background
  • Summary of 2021 Final Rule Changes
  • E&M Coding and Documentation (Total Time/Medical Decision Making)
  • E&M Code wRVU Changes
  • 2021 Conversion Factor Impact on Reimbursement and Provider Compensation

Initial Medicare Physician Fee Schedule 2021 Final Rule Key Takeaways Released by HSG in Early December Included:

  1. The final CY 2021 PFS conversion factor is $32.41, a decrease of $3.68 from the CY 2020 PFS conversion factor of $36.09. An overall decrease of 10.2%.
    1. This is only slightly different than the proposed conversion factor of $32.26 – or a decrease of $3.83 (10.6%).
  2. E/M coding and documentation changes to start January 1st. Coding will be based on time spent or Medical Decision Making (MDM).
  3. E/M wRVU credit increases that may significantly impact 2021 productivity-based compensation unless alternative arrangements are designed based on contractual latitude. 
  4. Finalized the definition of HCPCS add-on code G2211(formerly referred to as GPC1X) for office/outpatient E/M visit complexity.
    1. Assumes that this code would ultimately be reported with 100% of office/outpatient E/M visits by specialties that rely on office/outpatient E/M visits to report the majority of their services.
  5. Finalized a separate payment for a new HCPCS code, G2212, describing prolonged office/outpatient E/M visits to be used in place of CPT code 99417 (formerly referred to as CPT code 99XXX) to clarify the times for which prolonged office/outpatient E/M visits can be reported.
    1. Used if total time spent exceeds that for codes 99215, 99205.
  6. Finalized that NPs, CNSs, PAs, CNMs, and CRNAs can supervise diagnostic testing within their scope of practice (and bill for the services).
  7. Adopted a new payment, on an interim final basis, for a new HCPCS G-code (G2252) describing 11-20 minutes of audio-only medical discussion to determine the necessity of an in-person visit.

In-depth review of 2021 Medicare Physician Fee Schedule Final Rule. Topics addressed throughout the session include: – Medicare PFS Background – Summary of 2021 Changes – E/M Coding Documentation (Total Time/MDM) – E/M Code wRVU Changes – 2021 Conversion Factor – Reimbursement Impact – Provider Compensation Impact

Terrence R. McWilliams, MD, FAAFP

Chief Clinical Officer and Managing Director, Employed Provider Networks