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2021 Medicare Payment Rule Boosts E/M Reimbursement

posted: December 10, 2020

The 2021 Medicare Physician Fee Schedule will provide much-needed increases in Medicare reimbursement for the evaluation and management (E/M) services provided by rheumatologists and other cognitive care specialties. The change will yield an approximate average 16% increase in reimbursement for rheumatology, depending on the mix of services provided and where a practice is located.

Under the new rule, providers will no longer have to use history and examination to select the level of an E/M visit. Rather, documentation guidelines for office services levels 2 through 5 will be based on either medical decision-making or total time spent by the provider. CMS also finalized separate payments for two new add-on codes, G2211 (replacing HCPCS GPC1X) and G2212 (replacing CPT 99XXX). The G2211 was created to capture the work for office/outpatient E/M visits not accounted for in the valuation of the primary office/outpatient E/M visit code, and G2212 is for prolonged services and can only be reported when time is used to select the visit level. (ACR Newsletter)

Take action

Increases in payment for E/M services necessitated major cuts elsewhere in the Medicare fee schedule.

Please contact your member of Congress — Ask them to support the “Holding Providers Harmless from Medicare Cuts During COVID-19 Act” (H.R. 8702), and request the bill’s inclusion in a larger, end-of-the-year legislative package today!

Physicians Grassroots Network