Medicare Physician Fee Schedule

The Centers for Medicare and Medicaid Services’ (CMS) 2020 Medicare Physician Fee Schedule (MPFS), includes changes to both Medicare physician payment and quality reporting program policies.

The Pennsylvania Medical Society’s (PAMED) Practice Support Team has analyzed the final rule and created seven Quick Consult fact sheets that provide guidance for physicians and practices on changes that may impact their practice of medicine.

Quality Payment Program - MIPS Year 4
CMS has made changes to the MIPS participation track of the Quality Payment Program for the 2020 performance year, including an increase to the performance threshold.

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Quality Payment Program - Advanced Alternative Payment Models Year 4
There are also changes in store for the Advanced APM participation track of the Quality Payment Program for the 2020 performance year.

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Documentation Changes
Find out about documentation updates designed to reduce administrative burden.

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Virtual Care Services
Find details on reimbursement for communication technology-based services.

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Appropriate Use Criteria (AUC) Updates
AUC is a consulting and reporting process meant to guide the physician with their treatment decisions, to maximize patient outcomes, while minimizing inappropriate or ineffective utilization of services when ordering advanced imaging for Medicare fee-for-service beneficiaries.

Due to the COVID-19 public health emergency, CMS is delaying the go-live date for mandatory participation to the AUC program until Jan 1, 2022. CMS encourages stakeholders to use the additional time to continue to learn, test, and prepare for the AUC program.

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Chronic Care Management and Principal Care Management Services
CMS has made changes to chronic care management coding requirements, including by adding a new Medicare-specific code for additional time spent beyond the initial 20 minutes.

In 2020, there will also be new coding for principal care management services for patients with only a single serious and high-risk condition.

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Transitional Care Management
CMS has finalized a provision to increase payment for transitional care management (TCM) services provided to beneficiaries after discharge from an inpatient stay or certain outpatient stays.

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Questions? Contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.

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