Physician Fee Schedule/Ambulatory Surgery Center Update
On December 27, the Consolidated Appropriations Act, 2021, passed by Congress, has modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS). Changes include:
- 3.75% increase in MPFS payments for CY 2021;
- Suspension of the 2% payment adjustment (sequestration) through March 31, 2021;
- Reinstatement of the 1.0 floor on the work Geographic Practice Cost Index through CY 2023; and
- Delayed implementation of the inherent complexity add-on code for evaluation and management services (G2211) until CY 2024.
This act delays significant Medicare payment cuts, which were set to be finalized by the MPFS on January 1, 2021. These cuts would have impacted some surgical specialties by up to 9 percent.
CMS has recalculated the MPFS payment rates and conversion factor to reflect these changes. The revised MPFS conversion factor for CY 2021 is 34.8931. The revised payment rates are available in the Downloads section of the CY 2021 Physician Fee Schedule final rule (CMS-1734-F) webpage.
In addition, CMS recalculated Ambulatory Surgical Center (ASC) rates for office-based covered surgical procedures and certain covered ancillary radiology services and diagnostic tests, as well as the budget neutrality adjustment applied to all ASC procedure payment rates. Revised ASC payment rates are now available in the Downloads section of the January 2021 ASC Payment Rates – Addenda webpage. The ASC scalar for CY 2021 is now 0.8547.
