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CMS Issues CY 2021 Physician Fee Schedule Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) released a Medicare Physician Fee Schedule (PFS) proposed rule for calendar year (CY) 2021.

In the rule, CMS proposes to adjust the conversion factor, which is used to determine physician payment rates for specific services, to $32.26 – a decrease of $3.83 compared with CY 2020. The PFS proposed rule also includes other provisions of importance to essential hospitals, related to Medicare reimbursement for telehealth services, the Quality Payment Program, and the Medicare Shared Savings Program.


Medicare reimburses practitioners under the PFS for a list of telehealth services updated through annual rulemaking. CMS proposes to add nine Healthcare Common Procedure Coding System (HCPCS) codes to the list on a category-one basis, meaning they will be permanent.

Additionally, CMS proposes to add 13 HCPCS codes to the list of category-three services, which will be reimbursable as telehealth services until the end of the calendar year in which the COVID-19 public health emergency (PHE) ends. The list includes levels one to three emergency department visit codes, as well as codes for psychological and neuropsychological testing.

Through previous rulemaking, CMS added to the list of reimbursable telehealth services only for the duration of the COVID-19 PHE. CMS seeks comment on adding more of those services to the list either permanently or on a category-three temporary basis. CMS does not propose to make permanent reimbursement for any audio-only evaluation and management codes, which it added during the COVID-19 PHE. However, CMS seeks comment on making payment and coding changes that would reimburse for certain audio-only codes.

CMS proposes changes and makes clarifications to its policies on remote physiologic monitoring (RPM) services. The agency proposes to permanently allow consent for RPM to be obtained at the time the services are provided – a change implemented during the PHE. Additionally, CMS proposes to allow two RPM service codes to be furnished by auxiliary personnel under the supervision of a physician.

Physician Supervision

During the COVID-19 PHE, CMS modified the requirements for direct supervision by physicians or practitioners, allowing them to supervise the provision of services using real-time interactive audio-video communications technology. CMS proposes allowing direct supervision requirements to be met using real-time interactive audio-video communications technology through Dec. 31, 2021.

Professional Scope of Practice

CMS proposes to make permanent its policy allowing nurse practitioners, clinical nurse specialists, certified nurse-midwives, and physician assistants to supervise diagnostic tests, as allowed by state law and licensure, if required statutory relationships with supervising or collaborating physicians are maintained. This policy was enacted during the PHE.

CMS also proposes to permanently finalize a policy allowing physical and occupational therapists to delegate maintenance therapy services to assistants, as clinically appropriate. Additionally, the agency would make permanent flexibility allowing pharmacists to provide services incident to the professional services provided by physicians or nonphysician practitioners, who bill Medicare Part B under the PFS, if the services are within the pharmacist’s scope of practice and applicable under state law. These policies were first implemented on a time-limited basis through interim rulemaking during the COVID-19 PHE.

Payment for Services of Teaching Physicians

Through interim rulemaking during the COVID-19 PHE, CMS instituted certain policies pertaining to teaching physicians’ supervision of residents. These policies included allowing teaching physicians to supervise residents through audio-video real-time communications technology. CMS seeks comment on whether to extend these policies permanently or through the end of the year in which the COVID-19 PHE ends.

Quality Payment Program Updates

In recognition of clinicians working to address the COVID-19 pandemic, CMS will not introduce any Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) into the program for the 2021 performance period, as previously finalized. Rather, the agency proposes refinements to the guiding principles of MVPs and criteria to support stakeholder engagement in codeveloping MVPs. As a result of these proposals, MVPs will not be available for MIPS reporting until the 2022 performance period or later.

Due to the impact of COVID-19, CMS proposes to use data submitted during the CY 2021 performance period, instead of historical benchmarks, to score quality measures in the MIPS.

Notably, CMS proposes – for the 2020 performance period only – to double the complex patient bonus to 10 points to account for the additional complexity of treating this population due to COVID-19.

The agency also proposes replacing the Alternative Payment Model (APM) scoring standard with a new, APM Performance Pathway (APP) reporting option in 2021. The APP, like an MVP, would comprise a fixed set of measures for each performance category.

Medicare Shared Savings Program

Changes proposed in the Medicare Shared Savings Program (MSSP) include removing the CMS Web Interface for reporting by accountable care organizations (ACOs) and aligning the MSSP quality performance standard with the proposed APP under the Quality Payment Program. Under this new approach, ACOs report one set of quality metrics that would satisfy the reporting requirements under both MIPS and the MSSP.

America’s Essential Hospitals is analyzing the proposed rule for comment and will send members a detailed Action Update in the coming days. Comments on the proposed rule are due to CMS by Oct. 5.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Shahid Zaman is a senior policy analyst at America's Essential Hospitals.

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