Physician Staffing Blog

Healthcare News and Trends

CMS to Pay Physicians More For Evaluation and Management, Less For Other Services

April 05, 2021

CMS Medicare Physicians

By Phillip Miller


The Center for Medicare and Medicaid Services (CMS) has made changes to how it pays physicians that went into effect on January 1, 2021.


The general effect of these changes is that physicians who provide primarily evaluation and management (E/M) services are likely to earn more for treating Medicare patients and physicians who primarily perform procedures are likely to earn less.


One of the changes CMS made was to increase Work Relative Value Units (wRVUs) metrics for a variety of Current Procedural Terminology (CPT) codes, as follows:

 CPTDescription 2020 w RVUs 2021 wRVUs % Change 
 99203  Office/outpatient new visit   1.42 1.6 12.6%
 99204 Office/outpatient new visit 2.43 2.6 7%
 99205 Office/outpatient new visit 3.17 3.5 10.4%
 99212 Office/outpatient est. visit .48 .7 45.8%
 99213 Office/outpatient est. visit .97 1.3 34%
 99214 Office/outpatient est. visit 1.5 1.92 29%
 99215 Office/outpatient est. visit 2.11 2.8 32.7%
     
 

Source:  Peak Performance Physicians


In order to maintain budget neutrality, CMS also reduced the RVU conversion factor from $36.0896 to $34.8931. Despite this reduction, the increased wRVU values for E/M codes are projected to cause certain types of physicians to realize higher earnings from Medicare. For example, endocrinologists may see 16% increases in Medicare reimbursement, rheumatologists 15%, hematologists/oncologists 14%, family physicians 13% and psychiatrists 7%. It should be noted, however, that these projected increases are based on a conversion factor reduction to $32.4085 which was included in CMS’ 2020 Final Rule and was later changed to $34.8931 in the year-end Covid relief bill. Therefore, reimbursement increases for these specialties may be higher than those listed above.


Radiologists, cardiac surgeons, anesthesiologists, critical care physicians and general surgeons are among those types of physicians projected to see the largest drops in Medicare reimbursement. Many other types of specialists will see drops as well.


Some of these physicians, many of whom have or are treating Covid patients, are displeased with these reductions. The effect on the physician workforce may be to cause some physicians to consider retirement or a move to locum tenens. Some of those still in private practice may opt to become employed to obtain the stability of a salary. Physicians seeing gains may ask that these changes be reflected in their production bonuses.    Those likely to be most affected will naturally be those with the highest percent of Medicare patients.


CMS also added about 60 CPT codes that it will pay for if provided through telemedicine for an indeterminate period of time.




Phillip Miller is Vice President of Communications for Merritt Hawkins and Staff Care, companies of AMN Healthcare. He can be reached at phil.miller@amnheatlhcare.com

 


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