CMS Releases 2021 Medicare Physician Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) released the 2021 Medicare Physician Fee Schedule final rule on Tuesday. The release came less than two weeks after the Trump administration announced changes to the Physician Self-Referral Law, also known as Stark Law.

As physician groups reviewed the new rule, a few key changes stood out. Though the streamlining of documentation processes was welcomed by physicians, as was an increase in payment for office/outpatient face-to-face evaluation and chronic disease management visits, the 10 percent decrease to the conversion factor was not. The new physician fee schedule conversion will be $32.41, down from $36.09 during CY 2020.

The reimbursement cuts resulting from the reduced conversion factor will impact many specialties and could have significant consequences for Medicare patients seeking surgical services. The American College of Surgeons released a statement asking Congress to prevent the new Physician Fee Schedule from taking effect. ACS Executive Director David B. Hoyt noted in the statement that “these policies will result in significant cuts to physician payment for most surgical services delivered to Medicare patients, exacerbate surgical workforce shortages, and worsen the crisis of rural hospital closures."

CMS stated in its press release that the new rule prioritizes CMS’ investment in primary care and chronic disease management. The rule also expands telehealth, adding more than 60 services to the Medicare telehealth list that will continue to be covered beyond the end of the COVID-19 pandemic. This comes also as an effort to improve rural health, making services available via telehealth where there would otherwise be little access to care.

Reduction in administrative burden for practitioners is achieved in part by “cutting red tape so that healthcare professionals can practice at the top of their license and spend more time with patients instead of on unnecessary paperwork.” Simplification of the coding requirements for evaluation and management (E/M) visits is another part of this, “reducing burden on doctors imposed by the coding system and rewarding time spent evaluating and managing their patients’ care,” said CMS Administrator Seema Verma in CMS’ press release. 

But, physician groups argue the beneficial changes aren’t enough to outweigh the conversion factor reduction, and the rule falls short in helping providers bear the significant financial strain exacerbated by the pandemic.

To read the full changes to the Physician Fee Schedule, go here.

To learn more about the recent changes to Stark Law, go here.