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Public Policy Newsletter Article

Opportunity to Provide Feedback on CMS Medicare Physician Fee Schedule and Quality Payment Program for 2021

  • 2020-08-27T15:00:00.000+0000
  • Washington DC
  • Author: Brittany Blocker

On August 3, the Centers for Medicare & Medicaid Services (CMS) released its proposed Medicare Physician Fee Schedule and Quality Payment Program for 2021, which updates the payment rates for physician services and expands the list of telehealth services that Medicare covers. The comment deadline is October 5, 2020. Biocom is seeking member feedback on this proposed rule. Please submit comments to Brittany Blocker, Manager of Regulatory Affairs, at [email protected] by September 11, 2020.

Payment Rate Updates
CMS is proposing a series of standard technical proposals involving practice expense which includes the implementation of the third year of the market-based supply and equipment pricing update, standard rate-setting refinements to update premium data involving malpractice expense, and geographic practice cost indices.

The proposed rule includes a budget neutrality adjustment that accounts for changes in relative value units (RVUs) that are converted into PFS payments rates, as required by federal law. Under the proposed rule, CMS would set the PFS conversion factor for 2021 at $32.26 when accounting for the budget neutrality adjustment, more than 10% less from 2020's conversion factor of $36.09.

Telehealth Additions
Category 1. CMS proposes to add nine Healthcare Common Procedure Coding System (HCPCS) codes to the list on a Category 1 basis, meaning they will be permanent. The nine HCPCS codes are related to visit complexity, prolonged visits, group psychotherapy, neurobehavioral status exam, cognitive impairment care planning, rest home/custodial care visits, and home visits.
• Care Planning for Patients with Cognitive Impairment HCPCS Codes 99483;
• Domiciliary, Rest Home, or Custodial Care services HCPCS Code 99334 and 99335;
• Group Psychotherapy HCPCS Code 90853;
• Home Visits HCPCS Codes 99347 and 99348;
• Neurobehavioral Status Exam HCPCS Code 96121;
• Prolonged Services HCPCS Code 99XXX; and
• Visit Complexity Associated with Certain Office/Outpatient E/Ms HCPCS Code GPC1X.

Category 3. Additionally, CMS proposes to add 13 HCPCS codes to the list of Category 3 services, which will be a temporary category to describe services added to the Medicare telehealth list during the public health emergency (PHE) for the COVID-19 pandemic. These services will only remain on the telehealth list through the calendar year in which the PHE ends.
CMS is proposing to add HCPCS codes related to rest home/custodial care visits and home visits that describe different services from the proposed Category 1 services, emergency department visits, nursing facility discharge day management, psychological and neuropsychological testing.
• Domiciliary, Rest Home, or Custodial Care services, Established patients HCPCS Codes 99336 and 99337;
• ED Visits HCPCS Codes 99281, 99282, and 99283;
• Home Visits, Established Patient HCPCS Codes 99349 and 99350;
• Nursing facilities discharge day management HCPCS Codes 99315 and 99316; and
• Psychological and Neuropsychological Testing HCPCS Codes 96130, 96131, and 96132, and 96133.
CMS is soliciting public comments on the current list of services temporarily added to the Medicare telehealth list during the PHE that CMS is not proposing to add permanently, or proposing to only add temporarily on a Category 3 basis.

Direct Supervision via Interactive Telecommunication
CMS is currently permitting direct supervision for incident-to services and other diagnostic services requiring that level of supervision, to be provided via the virtual presence of a supervising physician or practitioner using interactive audio/video real-time communications technology (85 FR 19245). CMS is proposing to allow direct supervision to be provided in this manner that is using real-time, interactive audio and video technology (excluding telephone only) through December 31, 2021.

CMS clarifies that licensed clinical social workers, clinical psychologists, physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) practitioners can furnish the brief online assessment and management services as well as virtual check-ins and remote evaluation services.

The rule also clarifies that the Medicare telehealth rules do not apply when a physician or other practitioner furnishes a service to a beneficiary using audio/video technology if the physician/practitioner and beneficiary are in the same location.

CMS is seeking public comments regarding patient safety and clinical appropriateness as well as any potential concerns related to induced utilization and fraud, waste, and abuse.

The rule proposes to extend the revision to the regulatory definition of direct supervision to include instances when a supervising physician or practitioner is overseeing other clinicians via interactive audio/video real-time communications technologies until December 31, 2021.

CMS is seeking public comment on whether it should impose "any guardrails" on that policy or consider extending it further.

Remote Physiologic Monitoring Services
Under the proposed rule, CMS clarifies Medicare payment policies for certain remote physiologic monitoring (RPM) services.
• CMS considers RPM services to be evaluation and management (E/M) services.
• The agency will again require that an established patient-physician relationship already exists for RPM services to qualify for Medicare coverage once the PHE declaration ends.
• Only non-physician practitioners (NPPs) and physicians eligible to provide E/M services are eligible to bill Medicare for RPM services.
• Qualifying clinicians may provide RPM services to patients with acute conditions and those with chronic conditions.
CMS also proposes to permanently adopt two clarifications to RPM services that were implemented under the federally declared PHE.
• Auxiliary personnel, including contracted employees, are allowed to provide certain RPM services if they are under a physician's supervision; and
• Providers are allowed to obtain patients' consent at the time RPM services are furnished


CMS is seeking public comment on whether current RPM codes accurately capture the full scope of clinical scenarios in which RPM services may benefit Medicare beneficiaries.

E/M Changes
CMS is proposing to align its evaluation and management (E/M) visit coding and documentation policies with changes laid out by the CPT Editorial Panel for office/outpatient E/M visits, beginning January 1, 2021. The agency proposes to revalue the following code sets that include, rely upon or are analogous to office/outpatient E/M visits commensurate with the increases in values we finalized for office/outpatient E/M visits for 2021:
• End-Stage Renal Disease (ESRD) Monthly Capitation Payment (MCP) Services
• Transitional Care Management (TCM) Services
• Maternity Services
• Cognitive Impairment Assessment and Care Planning
• Initial Preventive Physical Examination (IPPE) and Initial and Subsequent Annual Wellness (AWV) Visits
• Emergency Department Visits
• Therapy Evaluations
• Psychiatric Diagnostic Evaluations and Psychotherapy Services


CMS is seeking public comment regarding how to clarify the definition of HCPCS add-on code GPC1X, previously finalized for office/outpatient E/M visit complexity, and whether it should refine our utilization assumptions for this code.