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Final 2021 Physician Fee Schedule Released
The Centers for Medicare & Medicaid Services (CMS) released the long-awaited final rule for the 2021 Medicare Physician Fee Schedule on December 1. These are the top takeaways from the final rule:
- Specialty Impact: 8 percent increase for reimbursement for urology.
- Conversion Factor: Conversion Factor: $3.68 Conversion factor decrease (from $36.09 in 2020 to $32.41 for 2021). The decrease in the final rule is $0.15 less than the proposed rule.
- Evaluation and Management Coding: Policies slated to go into effect in 2021 generally remain unchanged.
- CMS finalized its policy to revise how it will consider total time for services, adding the pre-, intra-, and post-service times rather than using the RUC times to be consistent with other services.
- The agency retained the complexity add-on code G2211 which can be billed with all outpatient E/M services related to primary care and certain care. CMS revised the code descriptor to read as follows: Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition. (Add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established).
- CMS created a new HCPCS code G2212 to be used when billing Medicare for a prolonged level 5 services (99205 or 99215) when billing by time. This would be billed in place of the already finalized CPT code 99417 to resolve any inconsistencies with CMS’ final policy that the add-on code only be billed for 15 minute intervals once the maximum time for level 5 services is exceeded.
- Telehealth: CMS is finalizing the addition of a number of codes to the telehealth services list as well as creating a third temporary category of criteria for adding services to the list of Medicare to create another list of temporary codes that could be delivered via telehealth to Medicare beneficiaries during the COVID-19 public health emergency. CMS is also establishing on an interim basis for CY2021 payment for a new HCPCS G-code for a virtual check-in describing 11-20 minutes of medical discussion to determine the necessity of an in-person visit. Despite comments from AUA and other stakeholders, CMS did not make any changes to its telephone E/M policy to allow these visits to be conducted with audio-only connections once the public health emergency concludes.
- CMS finalized a number of changes regarding direct supervision and scope of practice issues. None of the policies in the final rule preempt state law and state licensing requirements still apply. The AUA wishes to highlight two policies in particular:
- 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, Medicare will permit direct supervision using real-time, interactive audio and video technology through the latter of the end of the calendar year in which the COVID-19 public health emergency ends or Dec. 31, 2021. In addition, the final rule permits teaching physicians to use interactive, real-time audio/video to interact with residents to meet supervision requirements in certain circumstances.
- Under the final rule, certain non-physician practitioners, such as physician assistants and nurse practitioners, can supervise the performance of diagnostic testing within their scope of practice if state law allows.
Code | Descriptor | Work RVUs | ||
---|---|---|---|---|
RUC Recommends | 2021 Proposed Rule | 2021 Final Rule | ||
CPT 558XX |
Ablation of malignant prostate tissue, transrectal, with high intensity-focused ultrasound (HIFU), including ultrasound guidance | 20.00 (survey median) | 17.73 | 17.73 |
CPT 57282 |
Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, iliococcygeus) | 13.48 | 11.63 | 11.63 |
CPT 57283 |
Colpopexy, vaginal; intra-peritoneal approach (uterosacral, levator myorrhaphy) | 13.51 | 11.66 | 11.66 (current value) |
CPT 57425 |
Laparoscopy, surgical colpopexy (suspension of vaginal apex) | 18.02 | 17.03 | 17.03 (current value) |
View the Medicare Physician Fee Schedule Final Rule fact sheet.
View the Quality Payment Program Final Rule fact sheet and FAQs [PDF].
View the full rule.
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