CMS Finalizes Cut to Many Physician Payments, Adds Telehealth Codes in 2021 Fee Schedule
By Joey Berlin

 1.26 interstate billing

Medicare has finalized its 2021 physician fee schedule, resulting in payment cuts to many physicians due to the much-maligned budget neutrality requirements the Texas Medical Association has advocated against.

The final regulation also added codes to its telehealth services list, and permanently adopted scope-of-practice expansions first offered to some non-physician professionals for the COVID-19 public health emergency.

Released Tuesday, the Centers for Medicare & Medicaid Services (CMS) fee-schedule rule cut the 2021  conversion factor  used to determine payments for certain physician services by about 10%.

In a fact sheet on the rule, CMS said the cut was partially a result of adjusting for “significant increases” for evaluation and management code visits. That adjustment was necessary because of budget-neutrality requirements, the agency said.

Many physicians will see decreased payments because of the cut. (The pre-published final rule includes an estimate of the financial impact on each specialty starting on page 1,521.)

In detailed remarks to CMS during the fee schedule proposal comment period, TMA had urged the agency to “work with Congress to stop penalizing doctors with the current budget-neutral methodology.”

TMA is reviewing the massive annual regulation and will report on key findings.

Other key pieces of the 1,994-page final regulation include:

  • Telehealth – CMS added several CPT codes to its telehealth list, including psychological and neuropsychological testing; home visits for established patients; and group psychotherapy.
  • Scope of practice – The agency made permanent scope-of-practice expansions it put in place for the public health emergency, permanently allowing nurse practitioners, physician assistants, clinical nurse specialists, and certified nurse-midwives to supervise diagnostic tests “within their scope of practice and state law.” Certified registered nurse anesthetists also will have the same diagnostic supervision authority. Those health professionals must maintain the relationships with supervising or collaborating physicians that Medicare requires.
  • Quality Payment Program (QPP) – Despite initially proposing a decrease, CMS kept the performance threshold for the QPP’s Merit-Based Incentive Payment System (MIPS) the same for 2021 as it was in 2020: MIPS participants again must score 60 points to avoid a penalty. The weighting of two of MIPS’ four performance categories will change: The Quality category will be weighted at 40%, a 5% decrease; the Cost category will increase in weight by the same amount. In its comments, TMA had called making any changes to the performance threshold during a pandemic “absurd.”
  • Electronic prescribing of controlled substances (EPCS) – Medicare will make its mandate for electronic prescribing of Schedule II-V drugs effective beginning in 2021, but the compliance process will be delayed until Jan. 1, 2022. CMS said it was doing so “to encourage prescribers to implement EPCS as soon as possible, while helping ensure that our compliance process is conducted thoughtfully.”
CMS also added two new principal care management payment codes for designated rural health clinics and federally qualified health centers. Principal care management codes provide payment for managing one serious chronic condition.

In addition to its fact sheet on the fee schedule, CMS published separate guidance and other resources on the final QPP provisions.

For help understanding Medicare payments, QPP, and many other aspects of your practice, TMA Practice Consulting offers highly rated practice consulting services and expertise. Get more information by calling (800) 523-8776 or via email.

Last Updated On

December 04, 2020

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Joey Berlin

Associate Editor

(512) 370-1393

Joey Berlin is associate editor of Texas Medicine. His previous work includes stints as a reporter and editor for various newspapers and publishing companies, and he’s covered everything from hard news to sports to workers’ compensation. Joey grew up in the Kansas City area and attended the University of Kansas. He lives in Austin.

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