CMS finalizes physician fee schedule, delaying controversial coding change

CMS finalized the Physician Fee Schedule and Quality Payment Program, delaying a controversial coding change that would have resulted in a payment cut for doctors.

The final rule also promotes access to virtual care and includes updates to make health information exchange more interoperable, as well as reducing several burdens for physicians in 2019 and 2020.

For 2021, CMS consolidated evaluation and management (E/M) office and outpatient coding payment rates, delaying the changes by two years. For some classifications, the rule ultimately lowers payment rates.

The delay of the E/M coding changes was met with support from the industry, including the American Medical Group Association.

“AMGA members were very concerned that CMS was moving too aggressively in its plan to streamline the payment and coding for E/M office visits, particularly those providers who treat a large number of complex patients,” AMGA President and CEO Jerry Penso, MD, MBA, said in a statement. “Maintaining the code for the most complex patient visits somewhat alleviates that concern.”

Similarly, the American Hospital Association voiced support for the delay, but was also concerned over a change to payments to doctors of Medicare Part B drugs. Specifically, the rule changes the wholesale acquisition price add-on for prescribed medications, from 6 percent to 3 percent.

“We also appreciate that the agency responded to our concerns and mitigated its proposal to consolidate evaluation and management codes for providers,” Ashley Thompson, AHA senior vice president of public policy analysis and development, said in a statement. “However, we are disappointed that CMS will reduce payments for certain new drugs, and continue its short-sighted 'site-neutral' policies that ignore the need for hospitals to modernize existing facilities so that they can provide the most up-to-date, high-quality services to their patients and communities."

See the final rule here.