CMS has issued the final rule for Medicare’s 2020 Physician Fee Schedule (PFS), and it’s a win for primary care doctors.
Under the rule, released November 1, doctors in the coming years will see higher reimbursements for evaluation and management (E/M)-related services as well as simplified requirements for billing and coding these services. Both have been long-standing goals of primary care doctors and the organizations representing them.
“Historic simplifications to billing requirements mean that clinicians will be able to focus on recording the information that’s most important to keeping a patient healthy,” Alex Azar, secretary of the U.S. Department of Health and Human Services, said in a statement. “As we move toward a system that pays more and more providers for outcomes rather than procedures, we look forward to freeing clinicians from even more of these burdens.”
Beginning Jan. 1, 2020, CMS will increase the PFS conversion factor—part of the formula used to translate relative value units (RVUs) into actual payments—to $36.09 from $36.04. Beginning Jan. 1, 2021, it will increase payments for office and outpatient E/M visits and provide enhanced payments for visits with payments with greater needs and multiple medical conditions.
CMS says the higher reimbursements will result from its decision to use the American Medical Association (AMA) Relative Value Scale Update Committees’ recommended values for office and outpatient E/M codes for 2021 and a new add-on CPT code for prolonged service time.
The agency also says it is aligning E/M coding with coding changes adopted by the AMA’s Current Procedural Terminology Editorial Panel for office/outpatient E/M visits. Those changes:
- reduce from five to four the number of levels for office/outpatient E/M visits for new patients
- revise the code definitions
- revise the times and medical decision-making process for all the codes,
- require performance of history and exam only as medically appropriate, and
- allow clinicians to choose the E/M visit level based on either medical decision-making or time
The American College of Physicians praised the changes outlined in CMS’s announcement. “ACP is extremely pleased that CMS’s finial payment rules will strengthen primary and cognitive care by improving E/M codes and payment levels and reducing administrative burdens,” ACP President Robert McLean, MD, said in a statement.
McLean added that the changes will help address the shortage of primary care physicians. “Fewer physicians are going into … primary care disciplines in large part because Medicare and other payers have long undervalued their services and imposed unreasonable documentation requirements,” he said.
CMS Administrator Seema Verma said in a statement that the new rule will reduce burnout by allowing doctors to spend less time on paperwork and more on caring for patients. “The Trump Administration’s final rule brings antiquated requirements … up to date with the current practice of medicine and will impact the current and future generation of clinicians,” Verma said.