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Physicians can breathe a little easier going into 2021 – Congress has erased the deep Medicare fee cuts CMS laid out in the final 2021 physician fee schedule as an offset to higher E/M pay rates.
It’s unclear what the legislation’s ultimate effect will be, but as part of the 5,593-page Consolidated Appropriations act of 2021 (CAA), Congress has waived Medicare’s budget neutrality requirement and stipulated instead a 3.75% boost, to be paid for with $3 billion in an additional funds transfer from the U.S. Treasury.
The bill also states that: “In the event the Secretary determines additional amounts are necessary, such amounts shall be available from the Federal Supplementary Medical Insurance Trust Fund,” effectively writing CMS a blank check to cover the cost of restoring physicians’ fees.
Physician societies welcomed the adjustments, which were finalized in the wee hours this morning before being passed by both houses a few hours later.  
President Trump is expected to sign the legislation.
Also under the CAA:
  • Implementation of HCPCS add-on code G2211 will be put off until 2024. The E/M add-on code would have paid physicians extra for care of complex patients during office visits.
  • Work geographic price index floor will be extended to the end of 2023. It had been set to expire Dec. 31.
  • Suspension of the 2% sequestration cut is extended to March 31. The suspension had been due to end on Dec. 31.
  • Congress enacted a surprise billing compromise. As MGMA notes, the provision “includes arbitration and prohibits consideration of government-set rates to resolve payment disputes.”
  • Value-based payment model thresholds will be frozen at 50% instead of being increased to 75% as planned. Qualifying APM Participants (QPs) meet thresholds for Advanced APM payment based on the proportion of payments they receive or patients they treat under the APM. Currently these thresholds are, respectively,  50% and 35%. These were going to shift to 75% and 50% in 2021; the bill freezes the current thresholds for two years.


Laura Evans, CPC

Written by Laura Evans, CPC

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