2021 Medicare physician fee schedule has good news for family medicine

Update: On Dec. 21, Congress delayed implementation of the primary care add-on code, G2211, for three years as part of the 2020 Year End Funding Bill and COVID-19 Emergency Funding, and it applied the savings to increase Medicare base payments for all services and specialties by an additional 3.75%. All other anticipated payment, coding, and documentation changes for 2021 are expected to go into effect as planned.

The Centers for Medicare & Medicaid Services (CMS) recently released the 2021 Medicare physician fee schedule final rule. It contained mostly good news for primary care, and an estimated increase of more than 10% in Medicare allowed charges for family physicians.

CMS confirmed that simplified billing and coding rules for office-based E/M services — and higher relative values for those services — will take effect Jan. 1, as expected.

The agency is also moving forward with add-on code G2211, which is meant to compensate physicians and other qualified health care professionals for the inherent complexity of primary care and other office visits.

CMS also finalized proposals to increase the values of certain codes, including those for the following services:

• Maternity services,
• Transitional care management services,
• Initial preventive physical examinations (i.e., “Welcome to Medicare” visits) and initial and subsequent annual wellness visits,
• Emergency department visits,
• Some behavioral health services.

Unfortunately, not all the news was good. CMS decided it will allow the prolonged services code to be billed only after the maximum total time of a level 5 E/M visit has been exceeded by at least 15 minutes. This differs from the CPT prolonged services code (which applies to all visits that exceed the minimum threshold of a level 5 visit by 15 minutes), so CMS created a new code, G2212, for prolonged patient visits.

The other bad news is that the amount Medicare pays per relative value unit — known as the conversion factor — is decreasing to $32.4085, which is $3.681 lower than in 2020. Despite the decrease, CMS estimates family physicians will experience a 13% overall increase in their Medicare allowed charges in 2021.

A summary of the 2021 physician fee schedule and fact sheet are available online. You can find additional details and a link to the final rule on the CMS website.

— Kent Moore, Senior Strategist for Physician Payment, American Academy of Family Physicians