Physician Fee Schedule

Spotlight

CMS issued the CY 2022 Medicare Physician Fee Schedule (PFS) final rule that updates payment policies, payment rates, and other provisions for services. See a summary of key provisions, effective on or after January 1, 2022:

  • Revises telehealth services under the Consolidated Appropriations Act, 2021; allows use of audio-only communications technology when furnishing mental health services in certain circumstances.
  • Finalizes recent changes to Evaluation and Management (E/M) visit codes, such as policies for split (or shared) E/M visits, critical care services, and services furnished by teaching physicians.
  • Modifies payment for therapy services furnished in whole or in part by a Physical Therapist Assistant or Occupational Therapy Assistant.
  • Updates a payment regulation for Medical Nutrition Therapy services.
  • Finalizes considerations for vaccine administration services.

CMS Notice Regarding Split (or Shared) Evaluation and Management Visits and Critical Care Services from May 25, 2021 through December 31, 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:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices

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.

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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.

Page Last Modified:
12/01/2021 08:00 PM