Everything you need to know about the new physician fee schedule

Everything you need to know about the new physician fee schedule

In July 2019, the Centers for Medicare & Medicaid Services (CMS) issued its Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2020. The new policies will take effect January 1, 2020. The proposed rule includes “proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS).”

Among the changes and updates proposed in the 2020 Physician Fee Schedule (PFS) are several adjustments in codes and payment rates:

CY 2020 PFS Rate setting and Conversion Factor

Relative Value Units (RVUs) are applied to each service for physician work, practice expense, and malpractice. They become payments rate after a conversion factor is applied. Those payment rates include an overall payment update specified by statute. The proposed CY 2020 PFS conversion factor is $36.09, a slight increase above the CY 2019 PFS conversion factor of $36.04.

Medicare Telehealth Services

The following codes are proposed for the list of telehealth services: HCPCS codes GYYY1, GYYY2, and GYYY3, which describe a bundled episode of care for treatment of opioid use disorders.

Payment for Evaluation and Management (E/M) Services

The proposed PFS consolidates the Medicare-specific add-on code for office/outpatient E/M visits for primary care and non-procedural specialty care that was finalized in the CY 2019 PFS final rule for implementation in CY 2021 into a single code describing the work associated with visits that are part of ongoing, comprehensive primary care and/or visits that are part of ongoing care related to a patient’s single, serious, or complex chronic condition.

Care Management Services

A number of the Chronic Care Management (CCM) services codes are proposed to be replaced with Medicare-specific codes to allow clinicians to bill incrementally to reflect additional time and resources required in certain cases and better distinguish complexity of illness as measured by time. Physicians involved in CCM provide care coordination and management services to beneficiaries with multiple chronic conditions over a calendar month service period.

Medicare Shared Savings Program (MSSP)

As part of the PFS proposed rule, CMS is soliciting comment on how to potentially align the Medicare Shared Savings Program (MSSP) quality performance scoring methodology more closely with the Merit-based Incentive Payment System (MIPS) quality performance scoring methodology, recognizing that accountable care organizations (ACOs) and their participating providers and suppliers dedicate resources to performing well on quality metrics. The goal is to align quality metrics across programs that will reduce burden and will allow ACOs to more effectively target their resources toward improving care.