CMS Releases Updated Conversion Factor for CY 2021

On December 27, the Consolidated Appropriations Act of 2021 modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS). Here are some of highlights:

  • Provided a 3.75% increase in MPFS payments for CY 2021
  • Suspended the 2% payment adjustment (sequestration) through March 31, 2021
  • Reinstated the 1.0 floor on the work Geographic Practice Cost Index through CY 2023
  • Delayed implementation of the inherent complexity add-on code for evaluation and management services (G2211) until CY 2024

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 for nursing home services are below.

Code

Total 2021

2021 Payment Rate

Total 2020

2020 Payment Rate

Percentage Change

 

RVUs

(CF=34.8931)

RVUs

(CF=36.0896)

2020-2021

99304

2.59

$90.37

2.55

$92.03

-1.80%

99305

3.73

$130.15

3.69

$133.17

-2.27%

99306

4.81

$167.84

4.73

$170.70

-1.68%

99307

1.27

$44.31

1.24

$44.75

-0.98%

99308

2.01

$70.14

1.94

$70.01

0.17%

99309

2.64

$92.12

2.57

$92.75

-1%

99310

3.9

$136.08

3.83

$138.22

-1.55%

99315

2.12

$73.97

2.05

$73.98

-0.01%

99316

3.03

$105.73

2.99

$107.91

-2.02%

99318

2.78

$97.00

2.71

$97.80

-0.82%

 

 

 

 

 

% = (new-old)/old

 

 

 

 

 

 

As we reported back in December, the Society had been advocating since August to eliminate the 8-10% cuts that were scheduled go into effect on January 1, 2021. We want to thank the thousands of Society members who took the time to write letters to Congress telling lawmakers exactly how these cuts will devastate access to care for millions of Americans. We were pleased to see Congress take action to mitigate that cut but we continue to be concerned that even with that action, clinicians who have worked incredibly hard to take care of the many patients and residents in our nation’s nursing homes, assisted living facilities, and other PALTC settings will still see a cut to their reimbursement.

We continue to stress that any such cut is unacceptable at any time, but especially during a pandemic. For that reason, the Society is taking active steps to work with all appropriate stakeholders to address inequalities in Medicare reimbursement for these vital services. The gains that were included in the CMS final rule for primary care services for office-based clinicians are paramount and must now be extended to other primary care services provided in various sites of care, especially PALTC. This is vital to ensure that the growing number of people who will require these services continue to have access to qualified and trained PALTC clinicians to care for them.