Physician Fee Schedule
Spotlight
Submit Comments by September 6th – Calendar Year 2023 Proposed Rule
CMS issued the Calendar Year (CY) 2023 Physician Fee Schedule (PFS) proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the PFS and other Medicare Part B payment policy issues. See a summary of key provisions. Proposals include:
- Modernizing coverage for behavioral health services and improving access and quality by allowing licensed professional counselors, marriage and family therapists, and other types of practitioners to bill Medicare under general supervision; allowing psychiatric diagnostic evaluations to serve as the initiating visit for behavioral health integration and paying clinical psychologists and licensed clinical social workers providing integrated behavioral health services as part of a patient’s primary care team; bundling certain chronic pain management and treatment services into new monthly payments; and covering treatment and recovery services from mobile units; read our blog for more information
- Expanding access to Accountable Care Organizations (ACOs) by incorporating advance shared savings payments to certain ACOs; allowing smaller ACOs more time to transition to downside risk; and creating a health equity adjustment to reward excellent care delivered to underserved populations; read our fact sheet for more information
- Adopting CPT changes in coding and documenting other evaluation and management (E/M) visits, including: hospital inpatient, hospital observation, emergency department, nursing facility, home or residence services, and cognitive impairment assessment
- Making several temporarily available telehealth services during the public health emergency (PHE) covered through CY 2023 on a Category 3 basis; extending the time these services are temporarily included on the telehealth services list following the end of the PHE
- Creating a new G-code for audiologists to bill for services without physician referral to allow patients direct access and receive care for non-acute hearing or balance assessments unrelated to hearing aids or examinations for the purpose of prescribing, fitting, or changing hearing aids once every 12 months
- Improving access to colon cancer screening by considering a follow-up colonoscopy to an at-home test a preventive service, and covering it for individuals 45 years of age and above in line with recommendations from the US Preventative Services Task Force
- Expanding the existing policy to include dental services, such as payment for dental examination and treatment preceding a kidney transplant or other organ transplant; and seeking comment on a process to better understand and define when additional dental services may be inextricably linked and integral to the clinical success of other covered medical services
We encourage you to review the rule, and submit formal comments by September 6, 2022.
CMS Notice Regarding Split (or Shared) Evaluation and Management Visits and Critical Care Services from May 25, 2021 through December 31, 2021
- Enf Instruction-split-shared-critical care-052521 FINAL (PDF) - Posted 05/26/2021
CY 2021 Physician Fee Schedule Update
On January 19, 2021, CMS issued a correction notice to the Calendar Year 2021 PFS Final Rule published on December 28, 2020, and a subsequent correcting amendment on February 16, 2021. On March 18, 2021, CMS issued an additional correction notice to the Calendar Year 2021 PFS Final Rule. These notices can be viewed at the following link:
On December 27, the Consolidated Appropriations Act, 2021 modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS):
- Provided a 3.75% increase in MPFS payments for CY 2021
- Suspended the 2% payment adjustment (sequestration) through March 31, 2021
- Reinstated the 1.0 floor on the work Geographic Practice Cost Index through CY 2023
- Delayed implementation of the inherent complexity add-on code for evaluation and management services (G2211) until CY 2024
CMS has recalculated the MPFS payment rates and conversion factor to reflect these changes. The revised MPFS conversion factor for CY 2021 is 34.8931. The revised payment rates are available in the Downloads section of the CY 2021 Physician Fee Schedule final rule (CMS-1734-F) webpage.
CMS is ready to process claims correctly and on time. You don’t need to wait to submit your claims.
CY 2021 Physician Fee Schedule Final Rule
The CY 2021 Medicare Physician Fee Schedule Final Rule was placed on display at the Federal Register on December 2, 2020. This final rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2021.
This final rule updates policies affecting the calculation of payment rates and includes misvalued codes. It also adds services to the telehealth list including a third temporary category for services added under the PHE, as well as certain other revisions to telehealth services. It also addresses direct supervision as it relates to interactive technology, payment for teaching physicians, and provides clarification on medical record documentation. Additionally, this final rule includes several regulatory actions regarding professional scope of practice for certain non-physician practitioners. This final rule also provides clarification to the implementation of Section 2005 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, which creates a new Medicare Part B benefit for Opioid Treatment Programs. The calendar year (CY) 2021 PFS final rule is one of several rules that reflect a broader Administration-wide strategy to create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation.
CY 2021 Physician Fee Schedule Proposed Rule with Comment Period
The CY 2021 Medicare Physician Fee Schedule Proposed Rule with comment period was placed on display at the Federal Register on August 4, 2020. This proposed rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2021.
This proposed rule proposes potentially misvalued codes and other policies affecting the calculation of payment rates. It also adds services to the telehealth list including a third temporary category for services added under the PHE, as well as certain other revisions to telehealth services. It also addresses direct supervision as it relates to interactive technology, payment for teaching physicians, and provides clarification on medical record documentation. Additionally, this proposed rule includes several regulatory actions regarding professional scope of practice for certain non-physician practitioners. This proposed rule also provides clarification to the implementation of Section 2005 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, which creates a new Medicare Part B benefit for Opioid Treatment Programs. The calendar year (CY) 2021 PFS proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation. CMS will accept comments on the proposed rule until October 5, 2020, and will respond to comments in a final rule. The proposed rule can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection.
Care Management
For a one-stop resource focused on new Care Management services under the Physician Fee Schedule, such as chronic care management and transitional care management services, visit the Care Management webpage.
Physician Center
For a one-stop resource focused on Medicare Fee-for-Service (FFS) physicians, visit the Physician Center webpage.