CHA News Article

CMS Issues CY 2021 Physician Fee Schedule Proposed Rule
For CFOs, CMOs, finance & reimbursement staff, quality staff

The Centers for Medicare & Medicaid Services (CMS) has issued its calendar year (CY) 2021 physician fee schedule (PFS) proposed rule. In addition to addressing annual payment updates for Medicare Part B clinicians and changes to the quality payment program, CMS includes several proposals to make certain COVID-19 telehealth and scope of practice flexibilities permanent, and delays clinical laboratory reporting requirements – including for hospital outreach laboratories – until 2022.

Comments on the proposed rule are due Oct. 5. 

More information is available in a CMS fact sheet. and CHA will provide members with a more detailed summary in the coming weeks. CMS will host a listening session on the proposed rule on Aug. 13 from 10:30 a.m. to noon (PT). Registration is available via CMS’ Medicare Learning Network.

Key highlights of the rule include:  

  • Annual Payment Update: As required by the Medicare Access and CHIP Reauthorization Act of 2015, CMS proposes a 0% payment update for the physician fee schedule for CY 2021. After applying the budget neutrality adjustment, the estimated conversion factor is $32.26 for CY 2021, a 10.61% decrease compared to the CY 2020 PFS conversion factor of $36.09. 
  • Evaluation and Management (E/M) Services: In the CY 2020 PFS final rule, the agency finalized changes to office and outpatient E/M visit coding and documentation policies to be effective for CY 2021. CMS proposes several modifications to its previously finalized policies, including clarifying the times for which prolonged E/M visits can be reported, and revising the times used for rate setting; and revaluing several codes that include, rely upon, or are analogous to E/M visits, corresponding with the increases in values finalized for E/M visits for 2021. In addition, CMS proposes to continue its previously finalized increased payments for E/M visits that will have a redistributive impact on different practice specialties, depending on the volume of E/M visits billed. Table 90 in the rule displays the specialty impact of the E/M and other proposed payment changes. 
  • Telehealth and Remote Services: CMS proposes numerous changes related to telehealth and other remote services to make permanent certain flexibilities allowed during the COVID-19 public health emergency. Among the changes, CMS proposes to add services to the approved list of Medicare telehealth services, revise the frequency limitations for telehealth on subsequent inpatient and nursing facility visits, allow licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists, and speech language pathologists to furnish certain communication technology-based services, and allow direct supervision to be provided using real-time, interactive audio and video technology (excluding telephone that does not also include video) through Dec. 31, 2021. CMS notes that, under current law, it cannot waive the requirement that telehealth services be furnished using an interactive telecommunication system involving two-way audio/video communication. 
  • Scope of Practice: CMS proposes several changes to expand health care providers’ scope of practice, including making permanent changes that allow certain nonphysician practitioners (NPPs) to supervise the performance of diagnostic tests – as well as the delivery of diagnostic psychological and neuropsychological testing services – as permitted by state law and scope of practice. CMS also proposes to allow physical therapy assistants and occupational therapy assistants to furnish maintenance therapy services as part of a maintenance program, and clarifies that physicians and NPPs, including therapists, are authorized to review and verify documentation added to the medical record by other members of the medical team for the purposes of billing. 
  • Clinical Laboratory Fee Schedule Reporting Requirements: CMS proposes to delay by an additional year the requirement that certain “applicable laboratories,” including hospital outreach laboratories, report their private payer data to establish payment rates for the clinical laboratory fee schedule (CLFS). Therefore, the next CLFS data reporting period will be delayed until Jan. 1, 2022, through March 31, 2022. The private payer laboratory data to be reported will still be based on the original data collection period of Jan. 1, 2019, through June 30, 2019. In addition, CMS extends the phase-in of payment cuts for CLFS services through CY 2024. As a result, there is a zero percent reduction for CY 2021, and payment may not be reduced by more than 15% for CYs 2022 through 2024. 
  • Medicare Shared Savings Program (MSSP): CMS proposes several changes to the MSSP quality performance standard and quality reporting requirements for performance years beginning on Jan. 1, 2021, to align with the Meaningful Measures initiative, reduce reporting burden, and focus on patient outcomes. 
  • Quality Payment Program: CMS proposes several changes to the Quality Payment Program for the 2021 performance year, including changes to the category weights, revisions to align with changes to the Hospital Promoting Interoperability Program requirements, and changes related to advanced alternative payment model participation.  

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