decisionhealth Newsletters, Part B News - 2020 Issue 8 (August)
CMS proposes 11% cut to 2021 conversion factor, confirms E/M coding overhaul
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Article Overview
This article reviews CMS’s proposed 2021 Medicare physician fee schedule changes and how they may affect physician payment, E/M services, telehealth, chronic care management, and other service categories. It is intended for coders, billers, compliance staff, and practice leaders who need a high-level view of proposed policy shifts, affected specialties, and the types of codes and services included in the rule. The discussion covers broad payment trends, code-set updates, temporary and permanent policy changes tied to the COVID-19 public health emergency, and the categories of new, revised, or potentially misvalued services under review.
Why This Topic Matters
The proposal could significantly change Medicare reimbursement patterns and the relative valuation of common office, care management, telehealth, and specialty services. Understanding the scope of the changes helps organizations assess operational impact and prepare for final rule updates.
Article Sections
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CMS proposes 11% cut to 2021 conversion factor and E/M overhaul
Overview of the proposed Medicare physician fee schedule changes and the broader payment redistribution tied to E/M office visit updates.
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E/M-similar codes get valued up
Discussion of service categories CMS identifies as analogous to office/outpatient E/M visits and how those categories are being reviewed in the proposal.
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Other E/M updates
Coverage of CMS requests for comment and proposed changes related to add-on services, prolonged services, and selected E/M-related policies.
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Some COVID-19 breaks will persist
Summary of proposed extensions, permanent changes, and post-PHE considerations related to telehealth, supervision, documentation, and remote services.
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Other revalued services
Discussion of potentially misvalued services, including a spinal procedure and related RVU review considerations.
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New codes cover cardio, biopsy services
Overview of proposed new CPT and HCPCS codes across cardiovascular, diagnostic, and procedural service areas, along with categories of new work RVU assignments.
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Chronic care management updates
Description of proposed changes affecting chronic care management and related care management services.
What You Will Learn
- What CMS proposed for the 2021 Medicare physician fee schedule
- Which broad service categories are being revalued or updated
- How the article frames the impact on E/M services and related payment changes
- What categories of telehealth and COVID-era flexibilities are discussed
- Which areas of the CPT and HCPCS manuals are highlighted for new or revised services
- What kinds of care management updates are included in the proposal
Who Should Read This
- Medical coders
- Professional billers
- Revenue cycle teams
- Compliance staff
- Physician practice managers
- Specialty practice administrators
- Healthcare consultants
Codes Discussed
Code Ranges Discussed
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