The Centers for Medicare & Medicaid Services (CMS) has released the final rule for the calendar year 2020 Physician Fee Schedule (PFS) and Quality Payment Program (QPP). The final rule for the PFS updates the conversion factor for the coming year and makes several other changes to the Fee Schedule. The PFS conversion factor for calendar year 2020 is $36.09 a $0.05 increase from 2019.
CMS finalized changes to evaluation and management (E/M) services. Most notable, CMS will retain five levels of coding for established patients and reduce the number of levels to four for new patients. CMS has also finalized several provisions related to substance use disorder treatment, including implementing aspects of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act).
There are several notable policy updates CMS finalized for the upcoming QPP performance period. Among these are new performance thresholds. For performance period 2020, CMS has finalized a performance threshold of 45 points and an additional threshold of 85 points for exceptional performance. For performance year 2021, these figures will be 60 and 85 points, respectively. The performance category weights remain unchanged from 2019 at 45% for quality, 15% for cost, 25% for promoting interoperability, and 15% for improvement activities.
Background on the Physician Fee Schedule
Payment is made under the PFS for services furnished by physicians and other practitioners in all sites of service. These services include, but are not limited to, office visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services.
In addition to physicians, payment is made under the PFS to a variety of practitioners and entities, including nurse practitioners, physician assistants, and physical therapists, as well as radiation therapy centers and independent diagnostic testing facilities.
Payments are based on the relative resources typically used to furnish the service. Relative value units (RVUs) are applied to each service for physician work, practice expense, and malpractice. These RVUs become payment rates through the application of a conversion factor. Payment rates are calculated to include an overall payment update specified by statute.
The fact sheet for the final PFS rule can be found here. The fact sheet for the final QPP can be found here.