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CMS Finalizes Physician Payment and Policies for 2020

Members & Publications

December 16, 2019

In November, the Centers for Medicare and Medicaid Services (CMS) released the 2020 Physician Fee Schedule Final Rule.  Your Academy submitted two comment letters on the Physician Fee Schedule Proposed Rule earlier this fall.  This final rule reflects several policies that have been modified based on comments as well as policies that have been finalized as proposed.  Your Academy will publish an online resource with more details regarding these changes in the coming weeks.  Below is a summary of what to expect come January 1, 2020.

  • CMS finalized the 2020 conversion factor at $36.0896 which is a slight increase of $0.05 over the 2019 conversion factor.
  • CMS finalized payment for four new codes likely to be billed by physiatrists:
    • 64451 Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance - $216 national payment rate
    • 64454 Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed - $218 national payment rate
    • 64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed - $416 national payment rate
    • 64625 Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance - $510 national payment rate
  • CMS finalized changes to payment for several somatic nerve injection codes
  • CMS finalized payment rates for two new codes for dry needling.However, CMS clarified that currently these codes are considered non-covered services.
    • 20560 – Needle insertion(s) without injection(s); 1 or 2 muscles(s)
    • 20561 – Needle insertion(s) without injection(s); 3 or more muscles
  • CMS finalized payments for opioid treatment programs including bundled payments for opioid use disorder services.
  • CMS finalized creation of two new principle care management services codes (GPP1 and GPP2) for patients with a single high-risk disease or complex condition not well accounted for in existing coding.
  • CMS finalized a proposal to redefine is physician supervision requirement for PA services such that CMS would rely on state law and state scope of practice rules.Your Academy objected to this proposal in our second comment letter on the proposed rule.

Stay tuned for additional details on the final rule coming soon.

Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.

 

 

 

 

 

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