CMS finalizes physician payment rule for 2021: 6 takeaways

CMS released its annual changes to the physician fee schedule for 2021, which updates the payment rates for physician services and expands the list of telehealth services covered by Medicare. 

Six takeaways from the 2,165-page final rule

1. Payment update. With the budget neutrality adjustment to account for changes in relative value units, as required by law, the physician fee schedule conversion factor for 2021 is $32.41, down 10 percent from $36.09 in 2020. 

2. Telehealth. The final rule adds more than 60 services to Medicare's telehealth list, ensuring they're covered beyond the end of the COVID-19 public health emergency. "These additions allow beneficiaries in rural areas who are in a medical facility … to continue to have access to telehealth services such as certain types of emergency department visits, therapy services, and critical care services," CMS said. The agency said it will gather more data and evaluate whether more services should be added. 

3. Direct supervision by interactive telecommunication technology. For the duration of the public health emergency CMS adopted a policy revising the definition of direct supervision to include virtual presence of the supervising physician or practitioner using real-time video communications technology. Under the final rule, direct supervision can be provided using real-time, interactive audio and video technology through Dec. 31, 2021. 

4. Evaluation and management coding and payment. The final rule makes changes to evaluation and management services and codes, including increasing the relative value of several services, such as maternity care bundles and end-stage renal disease capitated payment bundles. 

"The finalized policy marks the most significant updates to E/M codes in 30 years, reducing burden on doctors imposed by the coding system and rewarding time spent evaluating and managing their patients' care," CMS Administrator Seema Verma said. "In the past, the system has rewarded interventions and procedures over time spent with patients — time taken preventing disease and managing chronic illnesses." 

5. Medicare Shared Savings Program. CMS finalized changes to the Medicare Shared Savings Program quality performance standards and reporting requirements for the performance year beginning Jan. 1. It is also providing automatic full credit for the Consumer Assessment of Healthcare Providers and Systems patient experience care surveys for performance year 2020. 

6. Professional scope of practice. Under the final rule, certain nonphysician practitioners, such as physician assistants and nurse practitioners, can supervise diagnostic testing if state law allows. 

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