2021 Physician Fee Schedule: The Highlights

Last week, the Centers for Medicare & Medicaid Services (CMS) issued a final rule with updates on policy changes for Medicare payments under the Physician Fee Schedule, going into effect on January 1, 2021. This final rule includes updates to payment policies as well as new guidelines and regulations related to telehealth. To keep our readers informed on how to be best prepared for the coming year, this blog will offer some highlights on the 2021 Physician Fee Schedule Final Rule.

To view full details of the 2021 Physician Fee Schedule, use this link.

Here are some of the more noteworthy elements of the 2021 Physician Fee Schedule:

• A budget neutrality adjustment has been made to account for changes in relative value units, so the 2021 Physician Fee Schedule conversion factor is $32.41, a 10 percent reduction from $36.09 in 2020.
• During the ongoing public health emergency, the definition of “direct supervision” will include virtual presence of the supervising healthcare provider using audio or video communications.
• Direct supervision can continue to be provided virtually until December 31, 2021.
• Payment policies have been clarified for remote monitoring CPT codes 99091, 99453, 99454, 99457 and 99458.
• Contract employees and other auxiliary personnel may provide remote monitoring services under CPT codes 99453 and 99454 while under physician supervision. This includes setting up of equipment and educating patients on its use.
• Once the public health emergency is over, 16 days of data per 30 days of remote monitoring must be collected and transmitted to meet the requirements of remote monitoring CPT codes 99453 and 99454.
• After the public health emergency is over, a patient-physician relationship must be established before remote monitoring services can be provided to the patient.
• For telehealth, the final rule has added more than 60 services to the Medicare list. These services will be covered even after the public health emergency has ended.
• The final rule also specifies that telehealth rules will not apply in situations where the provider and patient are in the same location.
• New changes to E/M Coding, the first significant updates to the code set in about 30 years, will take effect on January 1, 2021.

As we move into the new year, you can bet that 2021 has even more changes in store for the healthcare community. Stay tuned to this blog for frequent regulatory updates that will keep you informed and help guide you and your practice as you navigate the road ahead.

To learn more about how Nextech can help your practice manage regulatory compliance and create a plan for short- and long-term success, fill out this form and a member of our team will be in touch soon!