The Centers for Medicare & Medicaid Services (CMS) released its final rule for the 2020 Medicare Physician Fee Schedule (MPFS) and other changes to Medicare Part B reimbursement policies, including proposals related to the Quality Payment Program (QPP).
The estimated impact of the final MPFS rule for both the hematology/oncology and radiation oncology specialties is 0% in 2020. However, the impact on individual physician practices will depend on the mix of services they provide; practices in certain states may also see a change due to the elimination of the 1.0 threshold previously applied to the geographic practice cost indices.
CMS finalized targeted cuts to oncology for two drug administration codes—96360 and 96372—which were misvalued in the 2018 final rule. The agency also aligned Evaluation & Management (E&M) coding with changes laid out by the Current Procedural Terminology (CPT) Editorial Panel. Thus, there will be five levels of CPT coding for established patients, four levels for E&M visits for new patients, and revised code definitions.
Furthermore, the rule revises the times and medical decision-making processes for all codes, and only requires providers to perform a history and exam when medically appropriate. Clinicians will be allowed to choose E&M visit levels based on medical decision-making or time. CMS will also adopt the American Medical Association’s Specialty Society Relative Value Scale Update Committee’s recommended values for office/outpatient E&M codes for 2021, and the new add-on CPT code for prolonged service time. These recommended values will increase payment for office/outpatient E&M visits.
Provisions in the rule also finalize 2020 QPP updates. ASCO is still analyzing the rule, but an initial assessment found that all Merit-Based Incentive Payment System (MIPS) performance categories will remain at their 2019 weights; however, the total MIPS score needed to avoid a negative payment adjustment will increase from 30 to 45 points. CMS also finalized its plan to establish “MIPS Value Pathways” in 2021 to reduce the burden of participating in MIPS and collect more meaningful performance data.
Learn more at asco.org/ascoaction.
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