The official count is in. While the plight of physician practices during the COVID pandmic is well-known, new data from CMS provides a full accounting of the grisly financial landscape.
Released Nov. 16, the 2020 Medicare claims data reveals a huge drop in E/M office visit encounters from the pre-pandemic period of 2019. Established patient visits fell nearly 21% from 231.7 million in 2019 to 192 million in 2020. That contributed to losses of nearly $3 billion in annual payments among the E/M office visit code set (99201-99215) alone.
| Established patient code claims, 2019 vs. 2020 |
| Code |
2019 claims |
2020 claims |
% change |
| 99211 |
3,150,536 |
3,691,971 |
14.7% |
| 99212 |
11,500,015 |
9,336,053 |
-23.2% |
| 99213 |
95,980,182 |
78,673,883 |
-22.0% |
| 99214 |
110,348,628 |
91,421,228 |
-20.7% |
| 99215 |
10,743,844 |
8,855,343 |
-21.3% |
| |
2019 total |
2020 total |
% change |
| |
231,723,204 |
191,978,478 |
-20.7% |
| Established patient payments, 2019 vs. 2020 |
| Code |
2019 payment |
2020 payment |
% change |
| 99211 |
$40,936,762 |
$56,312,164 |
27.3% |
| 99212 |
$321,880,699 |
$263,519,226 |
-22.1% |
| 99213 |
$4,500,593,626 |
$3,691,560,262 |
-21.9% |
| 99214 |
$7,649,870,527 |
$6,284,295,212 |
-21.7% |
| 99215 |
$1,035,929,950 |
$865,459,519 |
-19.7% |
| |
2019 total |
2020 total |
% change |
| |
$13,549,211,563 |
$11,161,146,383 |
-21.4% |
The series of five new patient codes (99201-99205) didn't fare any better. Payments dropped 22%, falling from $2.6 billion in 2019 to $2.1 billion in 2020.
After years of increasing utilization, 2020 marked a stark drop in payments among nearly all of the office visit code set. The lone bright spot was low-level code 99211, which gained about 27% in payments. The higher-level visits suffered significant losses across the board, as you can see in the chart here:
The chart above shows payments for established office visits from 2016 to 2020, detailing specific dollar amounts for years 2019 and 2020. It appears that practices made up for some of the E/M losses through other means, such as audio-only services, which spiked tremendously: For example, the three telephone E/M service codes, 99441-99443, exploded from 22,793 claims in 2019 to over 11 million in 2020.