Medicare final rule for CY 2020 PFS

On November 1, 2019, CMS issued a final rule to make changes to the Physician Fee Schedule (PFS) rules and other related policy changes. Major aspects of the final rule include updates to the PFS rates, changes to the leveling codes, new fee schedule reimbursement for aspects of patient care managements, updates to MIPS, and new provisions for reimbursement for opioid substance abuse related treatment.

Fee schedule rate update 

Under the proposed rule, CMS would increase physician fee schedule rates by 0.14% in calendar year 2020 as shown in the following table:

E/M (Evaluation and Management leveling codes)

CMS added consistency to E/M coding by adopting changes set forth by the American Medical Association (AMA) to Current Procedural Terminology (CPT) codes.

Care management

In an effort to improve payment for care management and coordination, CMS expanded the codes associated with these services. CMS is attempting to eliminate gaps in payment for care management through this rule. The ruling recognizes the importance of care management for treatment of patients with chronic conditions.

Merit-Based Incentive Payment System (MIPS)

CMS proposed to take steps to align the reporting requirements across the four MIPS performance categories to reduce the burden on physicians. In the final rule, CMS refined two rules for the Shared Savings Program to achieve this objective. The two measures are being tracked under the program as “Pay-for-reporting” due to significant changes in the underlying measurement. “Pay-for-reporting” requires that providers submit quality data to receive credit for the measure. The measures impacted relate to Prevention Quality Indicate #91: Ambulatory Sensitive Condition Acute Composite and Preventative Care and Screening for Tobacco Use.

Coverage for opioid use disorder treatment

CMS indicated it is finalizing codification of a new Medicare benefit category that would outline payment for treatment of opioid use disorder furnished by Opioid Treatment Programs (OTP). This is part of an effort on Medicare’s behalf to pay for treatment in an OTP based on methods that have a track record of success.

Source: CMS.gov Fact sheet, https://www.cms.gov/newsroom/fact-sheets/proposed-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-2