CY 2021 MPFS Final Rule | ASCRS

CY 2021 MPFS Final Rule

 CMS also released a fact sheet on the CY 2021 Quality Payment Program Final Rule, as well as a fact sheet on the CY 2021 Physician Fee Schedule Final Rule. 

2021 MPFS Conversion Factor
The CY 2021 MPFS conversion factor is $32.41, which reflects a 10.2% budget neutrality adjustment and the 0.00% update adjustment factor as established in MACRA. This represents a decrease of $3.68 from the CY2020 MPFS conversion factor of $36.09.  

E/M Payment and Documentation

The final Medicare Physician Fee Schedule (MPFS) for 2020 included a restructuring and revaluing of the office-based Evaluation and Management (E/M) codes, including the creation of a new add-on code (GPC1X) effective January 1, 2021, which results in increased primary care payments. The 2021 MPFS Final Rule makes no real changes except to clarify the definition for the new HCPCS add-on code, formerly referred to as GPC1X, that is now G2211 and refine utilization assumptions for this code. Therefore, adhering to budget neutrality requirements for implementing this new policy results in sizable cuts for the surgical specialty community, including ophthalmology. The impact of the CY 2021 MPFS Final Rule represents an estimated 6% reduction in total allowed charges for ophthalmology.

CMS Makes No Changes to Increase the Value of E/M Visits Included in 10- and 90-Day Global Codes

As we have previously reported, despite intense advocacy from ASCRS, the AMA, and the surgical community that included a direct meeting with CMS and bipartisan letters from Congress, CMS indicated in the 2020 MPFS Final Rule they would not adopt changes to the 10- and 90-day global surgery codes, as they continue to evaluate the data. The 2021 MPFS Final Rule makes no changes to this policy.

ASCRS and the surgical community oppose CMS’s policy because it disrupts the relativity of the physician fee schedule by changing the value of some E/M services, but not all, and violates current law that requires Medicare to reimburse physicians equally for the same services regardless of specialty. In addition, CMS’s rationale for not increasing the values because of its ongoing data collection on post-operative care in the global codes runs afoul of the MACRA statute that gave it the authority to study the codes but noted that CMS should continue to update individual code values. We maintain that if CMS identifies specific codes it believes are overvalued, it should refer them to the RUC for review as part of the misvalued code initiative. In addition, we continue to remind CMS that these values have been increased each time E/M services were revalued since the advent of the physician fee schedule and the Resource-Based Relative Value Scale (RBRVS) in 1992.

ASCRS will continue to work with the surgical and specialty community in urging Congress to implement the surgical community’s 3-point plan for addressing the E/M related payment cuts before the end of the year: adjusting the E/M portion of the 10- and 90- day global codes; halting the implementation of the GPC1X add-on code; and holding physicians harmless from additional cuts caused by the new E/M policies.

As part of this effort, we are urging members of the House of Representatives to co-sponsor H.R. 8702, the “Holding Providers Harmless from Medicare Cuts During COVID-19 Act” – bipartisan legislation introduced in the House by Reps. Ami Bera, MD (D-CA); Larry Bucshon, MD (R-IN); Brendan Boyle (D-PA); George Holding (R-NC); Raul Ruiz, MD (D-CA); Phil Roe, MD (R-TN); Abby Finkenauer (D-IA); and Roger Marshall, MD (R-KS) – which includes a framework that will hold all physicians harmless from any cuts in 2021 and 2022.

In addition, today, at the request of ASCRS, Senator Rand Paul, MD (R-KY), introduced the “Medicare Reimbursement Equity Act of 2020,” legislation that mandates CMS incorporate the increased E/M values in the global codes.

Medicare Telehealth and Other Services Involving Communications Technology

For CY 2021, CMS will add a list of services to the Medicare telehealth list on a Category 1 basis. These services are similar to the services already on the telehealth list. Additionally, they are creating a third temporary category of criteria for adding services to the list. Category 3 describes services added to the Medicare telehealth list during the public health emergency (PHE) due to the COVID-19 pandemic that will remain on the list through the calendar year in which the PHE ends.

Quality Payment Program

CMS continues to propose modifications to the Quality Payment Program (QPP), which includes the Merit-Based Incentive Payment System (MIPS) program.

Key proposals for CY 2021 MIPS performance, which impacts 2023 payment:

  • Increasing the MIPS performance threshold from 45 points in 2020 to 60 points.

  • The exceptional performance threshold will be 85 points.

  • Revising category weights for Quality (40%) and Cost (20%)

CMS had finalized a new participation pathway: MIPS Value Pathways (MVPs), that would begin in the 2021 performance year. However, due to concerns expressed by ASCRS and the physician community on this timeline and with the added burden of the pandemic, CMS will not be introducing the MVP into the program in 2021. However, they have finalized additions to the framework’s guiding principles and the development criteria to support stakeholder involvement in codeveloping MVPs in future rulemaking for the 2022 performance period.

CMS is also offering a new Alternative Payment Model (APM) Performance Pathway (APP) reporting option in 2021 to align with the MVP framework. As part of this effort, CMS is sunsetting the CMS Web Interface as a collection type beginning in 2021 performance period.

Additional Details to Come

Additional information will be detailed in upcoming editions of Washington Watch Weekly.

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