CMS Retracts Detrimental Changes to Evaluation and Management Services

Last night, the Centers for Medicare and Medicaid Services (CMS) announced its proposed 2020 Physician Fee Schedule rule, which will change payment policies under the physician fee schedule and other Part B payment policies.  We are pleased to announce that CMS decided not to finalize several changes introduced in its 2019 rule for 2021 payment policies that, if implemented, would be detrimental to endocrinologists. Over the last year, we advocated through the American Medical Association CPT and RUC process and worked with cognitive specialty groups to ensure that proposed changes to evaluation and management (E/M) services did not take effect. The original proposed changes included a single payment rate for all level 2-4 office outpatient visits, which would have reduced reimbursement for endocrinologists.  (You can read our original comments here.) In its proposed 2020 rule, CMS proposed the following for E/M services starting in 2021:

  • A separate rate will be established for all level 2-4 E/M services rather than a blended rate.
  • Physicians can select the E/M visit level based on medical decision making or time.
  • Level 5 E/M codes will be retained for established patients.
  • A new add-on code for prolonged service time will be established.

We will analyze the proposed rule in greater detail and will provide you with additional information on how this will affect your practice in the coming weeks. In addition, we will provide an in-depth analysis of the rule as well as updates to the Quality Payment Program at CEU Miami on September 7 at 7am.  We thank all Endocrine Society members who worked with us to successfully advocate for E/M payment and who completed the RUC survey, which helped influence CMS’s decisions.