Medicare finalizes physician fee schedule and Quality Payment Program for 2020

Last week, the Centers for Medicare & Medicaid Services (CMS) released the final rule on the 2020 Medicare physician fee schedule.

Among the highlights for 2020:

• The amount Medicare pays per relative value unit (i.e. the conversion factor) is increasing from $36.0391 to $36.0896.
• CMS is increasing payment for transitional care management services.
• CMS created a Medicare-specific code, G2058, for additional time spent beyond the initial 20 minutes allowed in the current coding for chronic care management services.
• CMS created new coding for principal care management services for patients with only a single serious and high-risk chronic condition (G2064 for at least 30 minutes per month of services provided by a physician or other qualified health professional, and G2065 for at least 30 minutes per month of services performed by clinical staff under the direction of a physician or other qualified health professional).

CMS also modified its documentation policy so physicians, physician assistants, and advanced practice registered nurses (APRNs) can review and verify (i.e. sign and date) rather than re-document notes made in the medical record by other physicians, residents, physician assistants, and APRN students, nurses, or other members of the medical team.

Beyond 2020, CMS finalized its proposal to align evaluation and management (E/M) coding for office/outpatient visits with changes made by the CPT Editorial Panel. Beginning in 2021, the finalized proposal will:

• Retain five levels of coding for office/outpatient visits for established patients;
• Reduce to four the number of levels for office/outpatient E/M visits for new patients;
• Revise the times and medical decision-making process for all office-based E/M codes and require performance of history and exam only as medically appropriate;
• Allow clinicians to choose the E/M office/outpatient visit level based on either medical decision-making or time.

In 2021, CMS also plans to implement an add-on code describing the work associated with visits that are part of ongoing, comprehensive primary care or ongoing care related to a patient’s single, serious, or complex chronic condition. CMS finalized its proposed values for the revised office/outpatient visit E/M codes and the add-on code. As a result, CMS projects that allowed charges for family physicians will increase 12% in 2021.

Regarding the Merit-based Incentive Payment System portion of the Quality Payment Program (QPP), CMS finalized policies that establish the following performance thresholds and category weights for the 2020 performance period (which impacts payment in 2022):

• Increased performance threshold to 45 points,
• Increased additional performance threshold for exceptional performance to 85 points,
• Maintained performance category weights as follows: 45% quality, 25% promoting interoperability, 15% cost, and 15% improvement activities.

More information is available from a CMS physician fee schedule fact sheet, an executive summary of the QPP portion, and a separate fact sheet on the QPP program.

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