CMS updates 2020 Medicare Physician Fee Schedule

Nov. 5, 2019

The Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates to payment policies, payment rates and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) effective on or after January 1, 2020.

The calendar year (CY) 2020 PFS final rule is one of several rules that reflect a broader Administration-wide strategy to create a healthcare system that results in better accessibility, quality, affordability, empowerment and innovation.

Payment is made under the PFS for services furnished by physicians and other practitioners in all sites of service. These services include, but are not limited to, office visits, surgical procedures, diagnostic tests, therapy services and specified preventive services.

In addition to physicians, payment is made under the PFS to a variety of practitioners and entities, including nurse practitioners, physician assistants and physical therapists, as well as radiation therapy centers and independent diagnostic testing facilities.

Payments are based on the relative resources typically used to furnish the service. Relative value units (RVUs) are applied to each service for physician work, practice expense and malpractice. These RVUs become payment rates through the application of a conversion factor. Payment rates are calculated to include an overall payment update specified by statute.

Updates include:

·   CY 2020 PFS Rate-setting and Conversion Factor

·   Medicare Telehealth Services

·   Evaluation and Management (E/M) Services

·   Physician Supervision Requirements for Physician Assistants (PAs)

·   Review and Verification of Medical Record Documentation

·   Care Management Services

·   Medicare Coverage for Opioid Use Disorder Treatment Services Furnished by Opioid Treatment Programs (OTPs)

·   Bundled Payments under the PFS for Opioid Use Disorders

·   Therapy Services

Other provisions include:

·    Ambulance Services

·    Ground Ambulance Data Collection System

·    Open Payments Program

CMS has the release.