2021 Medicare final fee schedule: 10% conversion factor cut offsets E/M gains, RVU cuts hit TKA and THA

Why This Topic Matters

Medicare payment updates can materially change revenue for physician practices, especially when valuation shifts in one area are offset by reductions elsewhere. This article helps readers understand which specialties and service categories are affected by the 2021 final rule and why orthopedic practices may see notable changes.

Article Sections

1. Medicare reimbursement overview and budget neutrality

   Introduces the overall payment environment for 2021 and explains the systemwide Medicare policy forces affecting physician reimbursement. Covers the context for the final rule and how changes are being balanced across services.

2. Calculation of the CY 2021 PFS conversion factor

   Presents the annual conversion factor update and summarizes the key components used in the calculation. Highlights the relationship between the fee schedule update and budget neutrality adjustments.

3. Some rise, others fall

   Describes how payment impacts differ by specialty after the redistribution of RVUs. Notes that office-visit-heavy specialties and procedure-heavy specialties are affected differently.

4. Finalized: 2021 E/M documentation changes

   Summarizes CMS’s adoption of updated office/outpatient E/M documentation policy and related coding framework changes. Also addresses the new prolonged services add-on introduced in the final rule.

5. Fee and RVU projections for E/M services, 2020 vs. 2021

   Presents comparative reimbursement and RVU data for common office/outpatient E/M services. Shows how the revised valuation framework changes expected payment patterns.

6. Surgery RVUs take a hit

   Focuses on orthopedic procedure valuation changes and the resulting Medicare payment effects for selected surgical services. Includes hip and knee replacement, toe amputation, and arthroscopic shoulder debridement discussions.

7. Spinal implant code could get a boost in 2022

   Covers a code under review for possible future revaluation and the factors CMS said it would evaluate. Discusses the broader implications of the review process for the next fee schedule cycle.