2020 Medicare Fee Schedule: Top Five Things for Physicians to Know

The 2020 Medicare physician fee schedule promises to lighten the administrative load for physicians in 2021 with news about changes in coding for outpatient evaluation and management (E/M) services.

CMS estimates that under their proposal, rheumatologists would see on average a 15% payment increase, beginning in 2021. The proposed coding changes recognize the value of time spent with complex patients. The final rule aligns E/M coding with changes laid out by the CPT Editorial Panel for office and outpatient E/M visits.  

Here are the summary highlights:

  • Beginning in CY2020, the final 2020 MPFS conversion factor is $36.0896 (2019’s was $36.0391) resulting in a slight increase of $0.05 above the CY 2019. 
  • Beginning in 2021, five levels of coding will be retained for established patients.
  • Beginning in 2021, the number of levels will be reduced to four for office and outpatient E/M codes for new patients.
  • Beginning in 2021, the times and medical decision-making progress for all office-based E/M codes will be revised (see AMA, CPT Office Revisions, Level of Decision Making) and performance of history and exam will be required only as medically appropriate.
  • Beginning in 2021, clinicians will be able to choose the E/M visit level based on either medical decision-making or time. 

The finalized rule will increase Medicare reimbursement for time-intensive healthcare services provided by cognitive specialists such as rheumatologists. These services include examinations, disease diagnosis, risk assessments, and coordination of care. The result will be an increase in reimbursement across the board for rheumatology beginning in CY2021.

Physician practices are encouraged to start planning now for the operational, infrastructural and administrative workflow adjustments that will result from this overhaul.