CMS finalizes updates to physician fee schedule for CY 2020

The Centers for Medicare & Medicaid Services today issued a final rule updating physician fee schedule rates very slightly in calendar year 2020 — increasing the conversion factor by 5 cents.

CMS finalizes a revised approach to paying for evaluation and management (E/M) services. Specifically, CMS will revert back to setting separate payment rates for all levels of E/M visits rather than blending payment rates for certain levels (as it finalized last year). Also building on changes in last year’s PFS rule related to teaching physician documentation, CMS will now permit physicians and certain non-physician practitioners to review and verify, rather than re-document, notes made in the medical record by other members of the medical team.

The final rule also adopts several provisions related to treatment of opioid use disorder. Specifically, the agency will implement a new statutorily required Medicare Part B benefit for OUD treatment services by Jan. 1, 2020; a new monthly bundled payment for management and counseling for OUD; and add three new codes describing a bundled episode for OUD treatment to the approved list of telehealth services.

CMS adopts several updates to the Merit-based Incentive Payment System. As urged by AHA, CMS will not increase the weight of the MIPS cost category for the CY 2020 reporting year. Additionally, CMS finalizes higher performance standards for earning positive payment adjustments under the MIPS. Starting with CY 2021 reporting, CMS will begin a phased implementation of MIPS Value Pathways that, over time, the agency believes will reduce burden and better align reporting requirements across the four MIPS performance categories.