The Centers for Medicare & Medicaid Services’ proposed rule on the Medicare Physician Fee Schedule describes previously finalized changes to its coding and billing policies for office/outpatient evaluation and management (E/M) visits. Beginning in 2021, CMS will eliminate the history and physical exam as elements for evaluation and management code selection and will instead allow physicians to choose the E/M visit level based on the extent of their medical decision making or on time spent on the day of the encounter. CMS also will increase the value of most office, outpatient and E/M services, but these increases will not apply to global surgery codes.

To offset the increase in payment for E/M, CMS must cut reimbursement for other services. The agency therefore proposes to decrease the conversion factor from $36.09 to $32.26—a significant change of approximately 10.6 percent. CMS estimates a 7 percent reduction in total allowed charges for general surgery services relative to its proposals for 2021. The American College of Surgeons will continue to oppose CMS’ failure to increase payment rates for the E/M portion of 10- and 90-day global surgical packages.

In addition, the MPFS includes proposed changes to coverage for telehealth services after the COVID-19 public health emergency ends. CMS proposes to add certain services to the Medicare telehealth list permanently, along with a series of services that may be added to the telehealth list temporarily and remain payable only through the calendar year in which the PHE expires. The agency also seeks stakeholder feedback on the development of permanent coding and payment for audio-only telephone E/M visits.

The ACS is evaluating these and other proposals to determine the impact on surgery and will submit comments to CMS. The proposed rule is available for public review, along with a fact sheet on its payment provisions. Contact regulatory@facs.org with questions.