NASS Insider

August 11, 2020

CMS Releases 2021 Medicare Physician and OPPS/ASC Payment Proposed Rules

Physician Payment Proposed Rule
In the 2021 Medicare Physician Payment Proposed Rule, the most significant proposed policy change is a reduction in the 2021 Medicare conversion factor of almost 11% due to budget neutrality requirements, mostly from increased payment for E/M codes. This is resulting in significant overall payment cuts for most procedural specialties. Congress is allowed to waive budget neutrality during a public health emergency. NASS Advocacy is continuing outreach to Congress related to COVID and requesting a pause to budget neutrality requirements for the next three years, to ensure that changes in underlying payment policies do not counteract efforts to protect our health care system and ensure patient access to care. If you have not yet taken action on this issue, you can do so in under five minute via the NASS Legislative Action Center: HERE

Additional proposed changes include:
  • CMS is proposing to permanently add several CPT codes to the Medicare approved telehealth list that have been added temporarily during COVID. They are seeking comments on how to address audio-only telephone E/M visits on a permanent basis.
  • CPT code 22867: Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level has been nominated as a potentially misvalued code and CMS is seeking comment.
  • It is proposed that implementation of the MIPS Value Pathway be delayed from 2021 to 2022 or later.
OPPS/ASC Payment Proposed Rule
In the 2021 Medicare OPPS/ASC Payment Proposed Rule, CMS is proposing to increase hospital outpatient and ASC rates by 2.6%. Other significant changes include:
  • CMS is proposing a three-year phase-out of the inpatient-only (IPO) list, a list of over 1,700 services that are allowed to be provided in an inpatient setting only under Medicare. This would allow physicians to determine the most appropriate setting. As part of this transition, numerous spine surgery codes are proposed for removal from the IPO list for 2021.
  • CMS is proposing to expand prior authorization requirements for cervical fusion with disc removal and implanted spinal neurostimulators when performed in the outpatient hospital setting.
NASS volunteers and staff are continuing to review both rules and will submit comments to CMS. The final rules are expected to be published by December 1 for implementation January 1, 2021.