As part of the evaluation and management coding (E/M) changes in 2021, CMS is redistributing payment amounts depending on the codes utilized. This is due to some codes being paid higher in 2021, while the overall payments to physicians are stable because of budget neutrality.

CMS announced a nearly 11% cut to the Medicare physician fee schedule’s conversion factor (CF), dropping it to a rate of $32.26 next year, down from $36.09 in 2020. Influencing the substantial decrease to the CF are the projected pay increases to the core set of E/M office visit codes (99202–99215). CMS confirmed that the E/M office visit codes remain on track for their first major overhaul in 25 years, according to the proposed 2021 Medicare physician fee schedule.

The agency continues with its previously announced plan to adopt a series of significant revisions to the documentation guidelines for the office visit codes, in line with changes that the American Medical Association (AMA) is adopting. The updates, which would focus code level selection on medical decision-making or time, are set to take effect Jan. 1, 2021.

The convergence of the E/M RVU boost with the slashed CF is expected to produce some major pay swings among specialties, according to projected financial analysis contained in the proposed rule. For instance, endocrinology is expected to see a 17% increase in allowed charges. Rheumatology is on track for a 16% gain, and family practice will see a 13% boost.

Conversely, radiology providers and nurse anesthetists are on pace for double-digit losses in allowed charges, at -11% each. Chiropractic is expected to lose 10%, and physical and occupational therapy will be out 9%.

The challenge for the specialties with reduced reimbursement is the already reduced patient volumes because of the pandemic. The AMA and others have already suggested that budget neutrality should not be applied to the revision of E/M codes.