E/M Services Return to Separate Medicare Rates in Physician Fee Schedule Final Rule

Posted on November 08, 2019

The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule to update the Medicare fee-for-service (FFS) physician fee schedule (PFS) to provide a slight increase for 2020.  Payment is made under the PFS for services provided by physicians and other practitioners in all sites of service, including but not limited to office visits, surgical procedures, diagnostic tests, therapy services and specified preventive services.

Highlights of the rule, which takes effect Jan. 1, 2020, include:

  • Revising payment for evaluation and management (E/M) services. The CMS will revert to establishing separate payment rates for all levels of E/M visits rather than blending payment rates for certain levels (as it adopted last year).
  • Allowing physicians and certain nonphysician practitioners to review and verify, rather than re-document, notes made in the medical record by other members of the medical team.
  • Adopting several provisions related to treatment of opioid use disorder (OUD). The CMS will implement a new, statutorily required, Medicare Part B benefit for OUD treatment services. The agency also established a new, monthly, bundled payment for management and counseling for OUD and added three new codes to the approved list of telehealth services that describe a bundled episode for OUD.
  • Updating physician supervision requirements for physician assistants (PAs) to give them increased flexibility to practice in accordance with state law and state scope of practice. In the absence of any state rules, the CMS is finalizing a revision to the current supervision requirement to clarify that physician supervision is a process in which a PA has a working relationship with one or more physicians to supervise the delivery of their healthcare services.
  • Increasing payment for transitional care management services, which are care management services provided to beneficiaries after discharge from an inpatient stay or certain outpatient stays. The CMS is creating a Medicare-specific code for additional time spent beyond the initial 20 minutes allowed in the current coding for chronic care management services, which are services provided to beneficiaries with multiple chronic conditions over a calendar month. The CMS is also creating new coding for principal care management services for patients with a single serious, high-risk chronic condition.
  • Updating the Merit-based Incentive Payment System (MIPS). In response to comments it received, the CMS is maintaining the weight of the MIPS cost category for the 2020 reporting year at the current 0%. The CMS also adopted higher performance standards for earning positive payment adjustments under the MIPS.

Members with questions should contact Vickie Kunz at the MHA.

Tags: CMS, FFS, opioid, MIPS, Vickie Kunz, PFS

Posted in: Member News

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