2021 Final Medicare Physician Fee Schedule

The 2021 Final Medicare Physician Fee Schedule (MPFS) was released late Tuesday.  The provisions contained within the 2,165 pages of final rule will be effective on January 1.  The Final Rule adopts many of the changes included in the Proposed Rule including:   

  • Extensive changes to the outpatient, office evaluation and management (E/M) guidelines
  • Permanent expansion of telehealth services
  • Expansion of APP services
  • Expansion of therapy assistant services
  • Expansion of teaching physician regulations
  • Increased payments for many E/M and similar services
  • Simplification of certain physical, occupational and speech therapy documentation requirements
  • Addition of opioid prescription review and substance use disorder screening requirements for Medicare annual wellness visits (AWV) and  initial preventive physical examination (IPPE) encounters 

As part of the MPFS, CMS also included two new Interim Final Rules (IFR), “Coding and Payment of ‘Virtual Check-In’ Services” and “Coding and Payment for Personal Protective Equipment (PPE)”. CMS is soliciting comments on the IFRs for the next 60 days.  The IFRs address the following decisions:

  • CMS has established HCPCS code G2252 to report extended audio-only assessment services with 11-20 minutes of medical discussion.  Coverage is limited to established patients and services may not originate from a related E/M service provided within the previous 7 days nor lead to an E/M service within the next 24 hours or soonest available appointment.
  • CMS has adopted price increases for PPE supplies utilized during the public health emergency (PHE) and reported with CPT 99072.  While CMS considers these supplies as “bundled” they will make increased payments for the related services that include the supplies.  

There are many additional important provisions.  We encourage providers to familiarize themselves with the new requirements and to spend the next month preparing for the sweeping changes.  We expect these changes to have significant impact on most organizations.  The successful implementation of the E/M revisions alone will require a substantial organizational commitment.

The press release is located at: https://www.cms.gov/newsroom

The Final Rule is located at: https://www.cms.gov/files/document/12120-pfs-final-rule.pdf

The list of services approved for telehealth is located at: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

HBE’s team of coding and compliance experts is available to assist you with implementation preparation, design and review of documentation templates, providing customized education and training for your staff , as well as auditing and monitoring,. We are also available to provide assistance with conducting risk assessments, internal investigations, charge description mater reviews and policy and procedure development.

DISCLAIMER:  This newsletter only summary information and highlights; it should be read in conjunction with the full article or document provided as a link.  Any advice or recommendations are general and specific questions should be directed to professional counsel.

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