Responding to a COVID-19
omnibus bill passed in late December, CMS revised the 2021 conversion factor that determines Part B fees to $34.89 -- a nearly 8% increase from the $32.41 rate that the agency had previously approved in the final 2021 Medicare physician fee schedule in December.
The increase will result in significant fee changes in 2021 compared to what providers expected as Jan. 1 dawned,
according to supplementary materials that CMS posted Jan. 4. Services that were due for major cuts will instead see minor clips, while frequently reported services already in line for a pay raise will go even higher.
Take debridement code 11721. Instead of a 9% pay cut in 2021, which would have left it with a non-facility rate of $42.46, the code will instead get shaved by 3% year-to-year, with a fee of $45.36. That's down from its 2020 rate of $46.56 (all fees par, not adjusted for locality). Destruction of a premalignant lesion (17000) swings from a 5% loss to a 1% gain under the revised conversion factor, closing at $67.34 compared with the expected rate of $63.52.
E/M services that were largely at the center of the budget neutrality-driven shake-ups ahead of 2021 are in line for an even larger pay increase than expected. Established office visit code 99214, the most-reported E/M service, had been in line for a 12% pay gain at $123.48 per encounter. Now the year-to-year increase accelerates to 19% in the non-facility setting, settling at $131.20. The 2020 rate was $110.43.
Fellow established E/M code 99213 goes from a 14% to a 21% boost, pushing to $92.47 per claim in 2021, up from $76.15 in 2020.
The change to the conversion factor also diminishes the impact of RVU cuts for many procedures. A total knee arthroplasty (27447), originally facing a 13% pay cut, will instead decrease by 7%, according to facility rates.
The conversion factor rate of $34.89 is official for all Part B fees, a CMS official confirmed to the Medical Group Management Association on Jan. 5. It remains to be seen if there will be further financial swings in the aftermath of the Consolidated Appropriations Act.
Editor's note: This is a breaking news story. Please check back for updates.