CMS pitches physician payment rule for 2021: 6 things to know

CMS released its annual proposed changes to the Physician Fee Schedule for 2021, which would update the payment rates for physician services and expand the list of telehealth services covered by Medicare. 

Here are six takeaways from the proposed rule

1. Payment update. With the budget neutrality adjustment to account for changes in relative value units, as required by law, the proposed Physician Fee Schedule conversion factor for 2021 is $32.26, down from $36.09 in 2020. 

2. Telehealth. CMS proposed adding several services to the Medicare telehealth services list during the public health emergency for the COVID-19 pandemic, including home visits for established patients and psychological and neuropsychological testing. The department also proposed adding the following services to the list of Medicare telehealth services on a Category 1 basis, meaning the services are similar to those already on the list: 

  • Visit complexity associated with certain office/outpatient evaluation and management 
  • Prolonged services 
  • Group psychotherapy 
  • Neurobehavioral status exam
  • Care planning for patients with cognitive impairment
  • Domiciliary, rest home or custodial care services
  • Home visits 

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 proposed rule, direct supervision could be provided using real-time, interactive audio and video technology through Dec. 31, 2021. 

4. Evaluation and management coding and payment. CMS proposed a refinement to clarify the times when prolonged office and outpatient evaluation and management visits can be reported. The department proposed revaluing eight code sets, including maternity services, therapy evaluation and transitional care services. 

5. Medicare Shared Savings Program. CMS proposed changes to the Medicare Shared Savings Program quality performance standard and reporting requirements for the performance year beginning Jan. 1, 2021. The department is also seeking comment on an alternative scoring methodology approach under the extreme and uncontrollable circumstances for performance year 2020. 

6. Comment period. Public comments on the proposed rule are due by Oct. 5. 

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