CMS Issues Proposed Rule on 2020 Medicare Physician Fee Schedule and Quality Measures

August 06, 2019

The Centers for Medicare & Medicaid Services (CMS) has issued the annual update to the Medicare Physician Fee Schedule (PFS). The rule proposes changes to certain quality measures for the upcoming year. Here is a brief summary of the rule:

  • Physician Fee Schedule Adjustment: The proposed calendar year (CY) 2020 PFS conversion factor is $36.09, a slight increase above the CY2019 PFS conversion factor of $36.04.
  • Medicare Telehealth Codes Added: Reimburse telehealth services for three HCPCS codes, GYYY1, GYYY2, and GYYY3, which describe a bundled episode of care for treatment of opioid use disorders.
  • Evaluation and Management (E&M) Coding Changes: Allow five E&M codes for existing patients and four codes for new patients beginning in CY2021. Changes also revise the times and medical decision-making process for all the codes and requires performance of history and exam only as medically appropriate. The CPT code changes also allow clinicians to choose the E/M visit level based on either medical decision making or time.
  • Physician Assistant (PA) Supervision: Relax the requirements for required physician supervision of PAs that would apply in states where the physician/PA relationship is not outlined in state law.
  • Re-documentation revisions: Further relax the documentation of medical record requirements that were instituted in last year’s PFS rule. Under the proposed rule, physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse-midwives could review and verify rather than re-document notes made in the medical record by other physicians, residents, nurses, students, or other members of the medical team.
  • Care Transitions: Proposes a payment increase for transitional care management, as well as a set of codes for chronic care management.

WHA staff will keep members posted on the developmnt and submittal of our comments on the proposed rule, which are due to CMS by September 27. For further information, contact WHA Vice President of Policy Development Laura Rose.

This story originally appeared in the August 06, 2019 edition of WHA Newsletter