AACU News & Notes

CMS 2021 Medicare Payment Rules Released

posted: August 7, 2020

The Centers for Medicare and Medicaid Services (CMS) has issued its annual proposed rule that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS), effective January 1, 2021.

AACU is still reviewing the 1,355-page rule, but we would like to share some of the key takeaways from the proposed rule, particularly as it relates to the urology community. We will share additional information on the impacts of the rule on physicians and how individual urology codes are affected in the coming weeks.

Perhaps the most notable change in the rule is a series of changes to the coding, documentation and payment of Evaluation and Management (E/M) office visits. The rule would allow offices to begin billing for more advanced E/M codes and adds services to the Medicare telehealth services list. The E/M overhaul and payment increases for office visits is offset by significant payment cuts to nearly all surgical specialties.

  • Proposed 2021 Medicare PFS conversion factor of $32.26 – down from $36.09 in 2020 (-11%)
  • A combined 8% increase in allowed overall charges ($1.803B) for urology (changes for individual codes may vary)
  • Under MACRA, a statutory physician payment update of zero percent for 2021
  • Proposed additional urology APC code (5378) bringing the total number of levels in the urology and related services series to eight
  • Several new codes added to the telehealth services list, and other telehealth waivers are made permanent, including the office or outpatient E/M visit code and certain home visit services
  • Proposed new MIPS pathway for participants in alternative payment models called the “APM Performance Pathway” (APP)
  • Implements the Appropriate Use Criteria (AUC) requiring physicians to consult the AUC prior to ordering advanced imaging services

The AACU plans to submit a formal comment letter on the proposed rule prior to CMS’ October 5, 2020 deadline. Please contact Yehuda Sugarman if you have any questions about the Medicare PFS Rule or would like to provide feedback that we can incorporate into our comment letter.

View the full rule and CMS fact sheet.

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