2021 Medicare

Medicare is making major changes particularly in its payments to health care professionals this year. This page is an effort to collect and report related information.

11 December 2020 – American Psychological Association Services, Inc. Reports “Psychologists likely to see increases for psychotherapy services, but pay cuts for other services in Medicare for 2021”.

9 December 2020 – DrHerz.us reports “Update 2021 Medicare Prices For Psychological Services”.

6 December 2020American College of Radiology reports a “coalition of more than 50 medical associations continues to press Congress to include “Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020,” (HR 8702) protections in any legislation passed before it adjourns at the end of December. HR 8702 allows pay increases for providers who often bill for E/M services but avoids corresponding cuts to radiologists and other providers due to Medicare’s budget neutrality requirements.”

4 December 2020 – American Psychological Association Services, Inc.: “CMS adopts deep Medicare fee schedule cuts for 2021: Newly announced Final Rule includes a 10.2% cut in the conversion factor used to calculate provider payments.” At https://www.apaservices.org/practice/clinic/medicare-fee-schedule

CMS.gov Physician Fee Schedule at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index includes link to the CY 2021 Medicare Physician Fee Schedule Final Rule <https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1734-f> and prior years’ proposed rules, comment periods, and final rules.

3 December 2020 – I posted a link to a comprehensive list of Telehealth Services that will be covered by Medicare in 2021. This includes information about whether audio-only interaction meets the requirements. The link is available here: https://twitter.com/ForwardPsych/status/1334498614580817925

1 December 2020 – GH Comment: Here is a first look at the implication of the 10.2% reduction in the CF on a few key psychological service codes:

1 December 2020 – Commentary, GH: The following is from the “final rule”:

CY 2021 PFS Ratesetting and Conversion Factor

CMS is finalizing a series of standard technical proposals involving practice expense, including the implementation of the third year of the market-based supply and equipment pricing update, and standard rate-setting refinements to update premium data involving malpractice expense and geographic practice cost indices (GPCIs).

With the budget neutrality adjustment, as required by law, to account for changes in RVUs including significant increases for E/M visit codes, the final CY 2021 PFS conversion factor is $32.41, a decrease of $3.68 from the CY 2020 PFS conversion factor of $36.09. The PFS conversion factor reflects the statutory update of 0.00 percent and the adjustment necessary to account for changes in relative value units and expenditures that would result from finalized policies.”

GH Comment: That’s a 10.2% decrease. As far as I can tell, that’s the largest single year change in the CF since 1992, and the largest ever decrease. Average change in the CF from 1992-2020 was 0.6% (SD = .04%) [including the down years]. The largest prior single year decrease was -5.38%, 2001-2002.

These charts show the value of the “Conversion Factor,” the key variable that regulates all prices for services in the Physician Fee Schedule. This gives you an idea of the unprecedented severity of he cuts likely to be seen across many procedure codes. Impact on specific codes will vary.

Resources

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“Update 2021 Medicare Prices For Psychological Services”

1 December 2020 – CMS “Fact Sheet,” Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021.

1 December 2020 – CMS Press Release, Permanent Expansion of Medicare Telehealth and related.

Telehealth Services Comprehensive List covered by Medicare in 2021. Includes information about which services meet requirements for audio-only interaction

Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021 – CMS Fact Sheet

Physician Fee Schedule landing page at CMS.gov including links to CY 2021 MPFS Final Rule and prior years’ proposed rules, comment periods, and final rules.

CY 2021 Medicare Physician Fee Schedule Final Rule

American Psychological Association Services, Inc. article on 2021 Conversion Factor cuts and CMS Final Rule