CMS Releases 2021 Physician Fee Schedule Finalizing 10% Cuts to Primary Care Physicians Practicing in PALTC

On December 1, 2020, the Centers for Medicare & Medicaid Services (CMS) released its final rule on the 2021 Physician Fee Schedule and Quality Payment Program. The rule included a nearly 10% cut to physician payments for evaluation and management (E&M) services in nursing facilities, assisted living, and home health effective January 1, 2021. CMS stated in the rule that they “did not propose to treat and revalue nursing facility visits, domiciliary visits and home visits as analogous to office/outpatient E/M visits.” CMS did not “agree with the commenters’ assertions that these visits are identical to the office/outpatient E/M visit codes.” With the budget neutrality adjustment, as required by law, to account for changes in RVUs, including significant increases for E/M visit codes, the final CY 2021 PFS conversion factor is $32.41, a decrease of $3.68 from the CY 2020 PFS conversion factor of $36.09. The PFS conversion factor reflects the statutory update of 0.00 percent and the adjustment necessary to account for changes in relative value units and expenditures that would result from finalized policies. The Society strongly disagrees with this assessment, calling CMS’ decision “unconscionable” in a press release on December 2, 2020.

The Society has already been working with Congress to address this issue and will now focus on finding a legislative solution prior to January 1, 2020. PALTC clinicians are encouraged to contact their members of Congress to ensure they take immediate action to stop these cuts. Members also are encouraged to speak out on social media platforms stating how such cuts would impact their patients and residents in PALTC.

Please take action now!

Medicare Telehealth

CMS finalized a frequency limitation for subsequent nursing facility telehealth visits to one visit every 14 days.

For CY 2021, CMS finalized the addition of the following list of services to the Medicare telehealth list on a Category 1 basis. Services added to the Medicare telehealth list on a Category 1 basis are similar to services already on the telehealth list:

• Group Psychotherapy (CPT code 90853)
• Psychological and Neuropsychological Testing (CPT code 96121)
• Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT codes 99334-99335)
• Home Visits, Established Patient (CPT codes 99347-99348)
• Cognitive Assessment and Care Planning Services (CPT code 99483)
• Visit Complexity Inherent to Certain Office/Outpatient Evaluation and Management (E/M) (HCPCS code G2211)
• Prolonged Services (HCPCS code G2212)

Additionally, CMS finalized the creation of a third temporary category of criteria for adding services to the list of Medicare telehealth services. Category 3 describes services added to the Medicare telehealth list during the public health emergency (PHE) for the COVID-19 pandemic (COVID-19 PHE) that will remain on the list through the calendar year in which the PHE ends; they include:

• Domiciliary, Rest Home, or Custodial Care Services, Established Patients (CPT codes 99336-99337)
• Home Visits, Established Patient (CPT codes 99349-99350)
• Emergency Department Visits, Levels 1-5 (CPT codes 99281-99285)
• Nursing facilities discharge day management (CPT codes 99315-99316)

Quality Payment Program

CMS added two additional measures to the skilled nursing facility measure set:

• Pneumococcal Vaccination Status for Older Adults
• Use of High-Risk Medications in Older Adults

The MIPS Value Pathways (MVP) program is being pushed to begin in 2022 now given the public health emergency.

The MIPS category weights for 2021 were finalized at:

• 40% for quality
• 20% for cost
• 25% for promoting interoperability
• 15% for improvement activities