The Centers for Medicare & Medicaid Services (CMS) announced a revised Medicare Physician Fee Schedule conversion factor of $34.8931 for 2021. This represents a 3.3% reduction from the 2020 conversion factor of $36.0869. CMS updated the conversion factor as a result of a provision in the $1.4 trillion Consolidated Appropriations Act of 2021 (H.R. 133), which was signed into law on December 27, 2020.
The legislation injects $3 billion into the Physician Fee Schedule in 2021, directing Medicare to make a 3.75% positive adjustment to physician payments in 2021, offsetting some of the 10.2% reduction originally finalized. This 3.75% increase is temporary in 2021. Following 2021, ASCO expects the conversion factor to be reduced by 3.75%—prior to budget neutrality adjustments—without congressional action. The legislation also placed a 3-year moratorium on payment for the add-on code (G2211) for inherently complex evaluation and management visits under the Physician Fee Schedule until 2024, further offsetting the cut.
ASCO’s internal analysis shows that the medical oncology specialty benefits from increased evaluation and management values with an estimated 12% rate increase. The gynecologic oncology specialty benefits with a rate increase of 5.4%, and the radiation oncology specialty is expected to receive a 2.1% rate increase. These rates are estimates, since actual rate changes will vary by practice, patient mix, and geographic location. CMS did not adopt updates to relative value unit (RVU) values for evaluation and management services included in global surgical and radiation services, resulting in disparate impacts by specialty. For the full report, visit https://practice.asco.org/sites/default/files/drupalfiles/2021-01/-PracticeNET-MPFS-Report.pdf.
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