CMS Releases CY 2021 Physician Fee Schedule Final Rule

December 2, 2020

On December 1, 2020, the Centers for Medicare & Medicaid Services (“CMS”) issued its annual Physician Fee Schedule (“PFS”) final rule.  The CY 2021 PFS final rule expands telehealth services available for rural areas, increases payment for E/M comparable visits, makes permanent several workforce flexibilities provided during the COVID-19 public health emergency (“PHE”) and includes updates on additional policy changes. 

In the CY 2021 PFS final rule, CMS is adding more than 60 telehealth services to the permanent Medicare telehealth list that will continue to be covered by Medicare after the PHE.  These additional services will permit beneficiaries in rural medical facilities such as a nursing homes to continue to have access to telehealth services like certain ED visits and therapy services made available during the PHE.  Medicare does not have statutory authority to cover and pay for telehealth services outside of rural areas, or generally, to allow beneficiaries to receive telehealth services in their home except under certain circumstances. 

Last year in the CY 2020 PFS final rule, CMS finalized an increase in the payment rates for E/M office visits and simplified coding and documentation for such visits, which go into effect on January 1, 2021.  Under the CY 2021 PFS final rule, CMS is increasing the value of certain E/M comparable services such as maternity care bundles, emergency department visits, end-stage renal disease capitated payment bundles and PT and OT evaluation services. 

CMS is also making permanent certain flexibilities provided during the PHE that allow non-physician practitioners to provide care within the scope of their training and licensure, without imposing additional Medicare restrictions. As an example, CMS will now allow nurse practitioners, physician assistants, certified nurse-midwives and certified registered nurse anesthetists to supervise the performance of diagnostic tests within the scope of practice and state law so long as these practitioners maintain the required statutory relationship under Medicare with supervising or collaborating physicians.

For additional information on the CY 2021 PFS final rule, please visit here. To view an unpublished PDF version of the CY 2021 PFS final rule, see here.