American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

CMS Releases CY 2020 Medicare Physician Fee Schedule Final Rule

The Centers for Medicare & Medicaid Services (CMS) November 1 issued the calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS) final rule. The American College of Surgeons (ACS) submitted detailed comments September 10 in response to the agency’s MPFS proposed rule issued earlier in the year, some of which is summarized below.

CMS finalized changes to its coding and billing policies for office/outpatient evaluation and management (E/M) visits. Beginning in CY 2021, the agency will retain the five-level office/outpatient E/M coding system for established patients and reduce the number of levels to four for new patient visits. CMS will eliminate history and physical exam as elements for E/M code selection and instead allow physicians to choose the E/M visit level based on the extent of their medical decision making or on time spent with the patient. The agency also will implement an add-on code for office visits that are part of ongoing primary care and/or management of patients with serious or complex conditions.

CMS accepted the American Medical Association Specialty Society Relative Value Scale Update Committee-recommended payment rates for office/outpatient E/Ms for CY 2021, which will increase the values of most of these services; however, the Agency will not apply such increases to global surgery codes. The College will continue to contest CMS’ failure to increase values for the E/M portion of 10- and 90-day global surgery packages.

In addition, the agency modified its medical record documentation requirements to allow certain nonphysician practitioners (such as physician assistants (PAs), nurse practitioners, clinical nurse specialists, certified nurse-midwives, and certified registered nurse anesthetists) to review and verify (sign and date), rather than redocument, notes made in the medical record by other physicians, residents, nurses, students, or other members of the medical team. CMS also updated its regulations on physician supervision of PAs to allow these health care professionals to practice more broadly in accordance with state scope-of-practice and other laws.

The MPFS final rule and related fact sheet are available online for public review. For more information, regulatory@facs.org with questions.

Read the full issue of NewsScope.