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CMS Provides Update to 2021 Final Physician Fee Schedule Rule

On December 27, 2020, CMS finalized updated payment rates under its Medicare Physician Fee Schedule Rule for the 2021 calendar year (CY). These updates were made to reflect the Omnibus COVID-19 Relief Legislation passed by the U.S. Congress on December 27, 2020.

Several items were included in the legislation that reduced the 11% conversion factor to around 4%. As a result, many procedures that would have otherwise had significant decreases in Medicare reimbursement will have either small decreases or small increases.

The new physician fee schedule conversion factor for 2021 is $34.89. That is higher than the conversion factor finalized in the rule released in December, but it is 3.3% less than the 2020 conversion factor.

Specifically, the legislation included the following components related to the Medicare Physician Fee Schedule:

  • A 3.75% increase in Medicare payments
  • Suspension of a scheduled 2% Medicare payment reduction that was part of previous legislation through March 31, 2021
  • Delayed implementation of the inherent complexity add-on code for evaluation and management services performed by internal medicine physicians (G2211) until CY 2024

It is important to keep in mind that the second item described above—the suspended 2% payment reduction—will expire on March 31, 2021, unless Congress moves to maintain the suspension through the end of the year or beyond.

To see the updated rules and files, see here: https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1734-f