AACU News & Notes

CMS 2020 Payment Rules Released

posted: August 15, 2019

The Centers for Medicare and Medicaid Services recently released proposed rules for the 2020 Medicare Physician Fee Schedule (PFS), which includes updates to the Quality Payment Program, Open Payments program and other Medicare Part B policies, and the Outpatient Prospective Payment System (OPPS)/Ambulatory Surgery Center (ASC) Payment System.

AACU is still reviewing the 1,700-page proposed rules, but we would like to share some of our initial findings that may impact the urology community. We will share additional information about the new rules and their impact on urology in the coming weeks.

  • A 2020 proposed Medicare PFS conversion factor of $36.09 — up from $36.04 in 2019
  • A combined 8% increase in allowable E/M office visits payments for urology ($1,739), effective CY 2021
  • A 1% increase in allowed overall charges for urology (changes for individual codes may vary)
  • Adoption of CPT Editorial Panel recommendation for E/M coding to maintain five levels for established patients and reduce the number of code levels to four for new patients
  • Streamlines the MIPS program by tailoring participation around episodes of care (“MIPS Value Pathways” approach)
  • Increases the MIPS performance threshold to 45 points (up from 30 in 2019) in order for MIPS-eligible clinicians to receive upward payment adjustments

AACU plans to submit a formal comment letter on the proposed rules prior to CMS’ September 27, 2019 deadline. Final rules will be released by CMS in November 2019.

Please contact Yehuda Sugarman if you have any questions about CMS’ proposed rules or would like to provide feedback that we can incorporate into our comment letter.

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