2020 Medicare Physician Fee Schedule: TCM Expands, E/M Confirmed

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2020 Medicare Physician Fee Schedule: TCM Expands, E/M Confirmed

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2020 Medicare Physician Fee Schedule2

If you don’t have time to comb through the 2020 Medicare Physician Fee Schedule Final Rule, you’re not alone.

Most physicians and staff are simply too pressed for time to figure out exactly what parts of the rule are relevant to their practice and specialty.

If that’s the case — don’t worry. We’ve sussed out the most significant updates from the over-2000 page document.

Keep reading to find out what you need to know to keep your practice afloat starting Jan. 1, 2020.

2020 Medicare Physician Fee Schedule Offers More Flexibility in Billing for TCM Services

CMS has increased payment for transitional care management (TCM) services in order to encourage clinicians to provide these services to beneficiaries after inpatient/selected outpatient stays.

CMS found that TCM services have been underused compared to the number of eligible beneficiaries.

Currently, there are 14 care management codes that providers can’t bill in combination with the TCM codes—this restriction has been lifted starting in 2020, and you can find a list of these codes in table 20 of the final rule.

CPT E/M Code Changes Confirmed

The 2020 Medicare Physician Fee Schedule Final Rule unpublished version released Nov 4, 2019, confirms that the E/M code changes take effect in 2021. Changes to E/M services will be significant — although the changes won’t take effect until 2021:

  • For new patients, there will be four levels of E/M codes instead of five. The definitions for each code level will change accordingly but are yet to be determined. For current patients, you’ll still have five levels of codes to choose from.
  • CMS will add a new add-on code (99XXX) to bill for prolonged E/M visits.
  • While RVUs for E/M codes will increase, those increases will be offset by reductions elsewhere (most likely in the conversion factor, which will affect payments for all services.). Changes to the physician fee schedule must be budget-neutral, meaning that when payment for some codes increases, others decrease.
  • If your practice often bills high-level codes, you’ll likely see a larger increase in payments, as opposed to practices that bill lower-level codes or fewer E/M codes overall (those practices are more likely to see a decrease in overall payments).

MIPS Gets Tougher

If you’re participating in MIPS, there are several changes to the Quality Payment Program (QPP) that you should be aware of:

  • While there is no change in the weights of each of the four performance categories (Quality, Cost, Promoting Interoperability, and Improvement Activities) the performance thresholds are changing. For 2020, the performance threshold will increase to 45 points (from 30), and the exceptional performance threshold is 85 points. For 2021, the performance threshold will increase to 60 points, but the exceptional performance threshold won’t change.
  • CMS has added several new specialty sets to the Quality Category. These include speech-language pathology, audiology, clinical social work, chiropractic medicine, pulmonology, endocrinology, and nutrition/dietician. Providers in these specialties will have specialty-specific quality measures to choose from.
  • CMS has added 10 new, episode-based measures to the Cost category.
  • If your practice is reporting as a group, the participation threshold for each Improvement Activity will increase to 50 percent of clinicians in the practice (this is an increase from the current requirement of one clinician in the practice).

Payment Impacts Varies by Specialty

There should be little change in overall Medicare physician payments since the conversion factor is staying flat at approximately $36.

Differences in payments will depend more on your specialty and service mix, depending on any changes to specific RVUs (relative value units) that are relevant to your practice.

Recommended Medicare Physician Fee Schedule Training