CMS Releases the 2020 Physician Fee Schedule Final Rule

CMS has released the finalized 2020 Physician Fee Schedule. The final rule is mostly unchanged from the proposed rule that was released in July. The most significant new policies are outlined below.

Several specialists, including psychologists and physical therapists face significant cuts that may threaten many practices across the country. Psychologists and social workers will receive a 7% drop in reimbursement, while physical therapists will endure a drop of 8%. These cuts will be implemented in 2021.

Fortunately, CMS is implementing the proposed changes to the E/M coding system. New patients will only have four layers of CPT codes, down from five for existing patients. Providers were crossing their fingers for an across-the-board simplification, but no such luck. Even so, this change will bring a significant reduction in compliance costs over time. The E/M system is in dire need of major reform, and this is a great start.

Continuing CMS’ “Patients over Paperwork” initiative, the final rule also allows clinicians to review and verify medical records, instead of re-documenting notes. CMS is working to achieve their goal of seamless interoperability across the entire healthcare spectrum, but first they must address these types of roadblocks. Expect to see many more small changes like this one in the future.

The Merit-based Incentive Payment System (MIPS) is being refined under the new rule. The Fee Schedule increases the minimum number of points clinicians require to avoid a negative payment adjustment under MIPS to 45 points in 2020, and then 60 points in 2021. MIPS has several small changes under the new rule, and participating providers should read CMS’ fact sheet on the new rule and visit the official MIPS website for more information.

The final rule increases resources in the fight against the opioid crisis as well. There is a new Medicare Part B benefit for opioid use disorder that includes medication-assisted treatment, beginning in January 2020. This is accompanied by a new monthly bundled payment and new telehealth codes related to the disorder.

There are many other changes in the 2,475 page 2020 Physician Fee Schedule. For more information, read CMS’ Fact Sheet and stay tuned for more analysis.

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