Physician Fee Schedule Updates May Increase Reimbursement, Time with Patients

2021 Physician Reimbursement Updates

Some updates to the evaluation/management codes on the 2021 Physician Fee Schedule will provide greater reimbursement to physicians and allow them to spend more time with patients, CMS and medical societies said.

According to CMS, the code sets that it is finalizing will increase the value of certain services. These include:

  • cognitive impairment assessment and care planning;
  • ED visits;
  • end-stage renal disease monthly capitation payment services;
  • initial preventive physical examination and initial and subsequent annual wellness visits;
  • maternity services;
  • psychiatric diagnostic evaluations and psychotherapy services;
  • therapy evaluations; and
  • transitional care management services.

The adjustments will help CMS ensure it is “appropriately recognizing the kind of care where clinicians need to spend more face-to-face time with patients,” the agency said in a press release.

“This finalized policy marks the most significant updates to E/M codes in 30 years,” Seema Verma, MPH, CMS administrator, said in the release.

CMS also finalized separate payment for a new Healthcare Common Procedure Coding System code, G2212, which will be used in place of CPT code 99417 “to clarify the times for which prolonged office/outpatient E/M visits can be reported.”

In addition, the agency finalized the add-on code G2211, which can be used for complex office/outpatient E/M visits, CMS said. Twelve medical societies, including the American Academy of Family Physicians and ACP, applauded the addition of G2211.

“This new ‘G code’ is an essential part of the anticipated pay increases for primary and cognitive care,” the societies said in a statement. “The add-on G code will improve care by allowing and paying for physicians to spend more time with their patients and on critical activities like chronic disease management tracking, review of consult and lab reports and medication monitoring that occur outside the office visit.”

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