CMS’ 2021 Fee Schedule Proposal Could Lower Physician Pay
By Joey Berlin


Payments to some physicians who treat Medicare patients would fall from 2020 levels under the Centers for Medicare & Medicaid Services’ (CMS’) proposed physician fee schedule for 2021.

CMS last week released the annual draft rule, which also recommends updates to the Quality Payment Program (QPP).

For physician payments, the rule proposes to cut the Medicare conversion factor for practice costs by more than 10% from this year’s amount, lowering it to $32.26 for 2021, and resulting in lower 2021 payments. The draft fee schedule leaves in place CMS’ previous overhaul of evaluation and management (E&M) coding for office visits, which was already scheduled to go into effect in 2021.

The agency’s 2021 fee schedule outline also would:

  • Permanently add nine codes to the Medicare telehealth list that were temporarily placed on the list because of the COVID-19 public health emergency, and temporarily continue 13 other codes during the emergency;
  • Revalue eight code sets that are tied to current office/outpatient E&M visit coding, including maternity services, emergency department visits, and therapy evaluations;
  • Specify that CMS will continue audio-only E&M payments during the public health emergency, but those payments won’t be permanent;
  • Revise payment rates for nine immunization services; and
  • Make permanent several changes to scope of practice put in place during the public health emergency, including allowing nurse practitioners and physician assistants to supervise diagnostic tests within state scope laws.

The Texas Medical Association is currently analyzing the 1,300-plus-page rule proposal and will weigh in by CMS’ Oct. 5 deadline to submit comments. You can find out more about the draft fee schedule in CMS’ summary fact sheets on the proposal and a separate fact sheet devoted to the QPP.

CMS will hold a listening session on the proposed physician fee schedule at noon (CT) Thursday, Aug. 13.  You can register for that session here.

Last Updated On

August 12, 2020

Originally Published On

August 10, 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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