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CMS CY 2021 Physician Fee Schedule (PFS) Final Rule Released

CMS CY 2021 Physician Fee Schedule (PFS) Final Rule Released

On December 1, CMS released the annual Physician Fee Schedule (PFS) final rule, prioritizing CMS’ investment in primary care and chronic disease management by increasing payments to physicians and other practitioners for the additional time they spend with patients, especially those with chronic conditions.


Key updates include the following:

  • 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.  (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)
  • Last year, CMS finalized a historic increase in -payment rates for office/outpatient face-to-face E/M visits that goes into effect in 2021.
  • 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)
  • 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)
  • Permanently allows Medicare providers to use telehealth to carry out home visits for so-called evaluation and management services and some visits for people with cognitive impairments
  • Temporarily continues telehealth services for emergency department visits and other services


For a full list of updated provisions please see the CMS fact sheet: https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-1

This post was first published December 2, 2020 and was updated December 3, 2020.

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