Skip to main content

Main menu

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
NewsDepartmentsF

FEE SCHEDULE SUMMARY: AAFP ADVICE VISIBLE IN CMS FINAL RULE

The Annals of Family Medicine January 2020, 18 (1) 84-85; DOI: https://doi.org/10.1370/afm.2508
  • Article
  • eLetters
  • Info & Metrics
  • PDF
Loading

The American Academy of Family Physicians (AAFP) has released a summary of the final 2020 Medicare physician fee schedule, available at https://www.aafp.org/dam/AAFP/documents/advocacy/payment/medicare/feesched/ES-2020FinalMPFS-110219.pdf, that emphasizes a significant change on the horizon: a payment boost stemming from ongoing Academy advocacy.

Specifically, the combined final rule and interim final rule that Centers for Medicare and Medicaid Services (CMS) issued November 1, 2019 calls for higher payments for evaluation and management codes, and the development of primary care add-on codes, resulting in a 12% increase in total allowed charges for family physicians starting in 2021.

The final 2020 MPFS conversion factor is $36.0896, resulting in no change in total Medicare-allowed charges for family medicine in 2020.

Evaluation and Management Services

The Academy had long advised CMS that undervaluation of evaluation and management (E/M) services slowed crucial investments in primary care. As supported by the AAFP, the final rule aligns E/M coding with changes laid out by the current procedural terminology (CPT) Editorial Panel for office and outpatient E/M visits, starting in 2021. This means that

  • 5 levels of coding will be retained for established patients

  • The number of levels will be reduced to 4 for office and outpatient E/M visits for new patients

  • The times and medical decision-making process for all office-based E/M codes will be revised, and performance of history and exam will be required only as medically appropriate

  • Clinicians will be able to choose the E/M visit level based on either medical decision making or time

CMS finalized the adoption of Academy-supported, American Medical Association (AMA)/Specialty Society Relative Value Scale Update Committee- recommended values for the office and outpatient E/M visit codes for 2021, as well as a new add-on CPT code for prolonged service time.

Quality Payment Program

As outlined in a CMS executive summary of the 2020 Quality Payment Program, the merit-based incentive payment system will operate with the following performance thresholds and category weights for the 2020 performance period (which equates to the 2022 payment year):

  • Performance threshold: 45 points

  • Additional performance threshold for exceptional performance: 85 points

  • Quality performance category weight: 45%

  • Cost performance category weight: 15%

  • Promoting interoperability performance category weight: 25%

  • Improvement activities performance category weight: 15%

For the 2021 performance period, however, CMS has raised the performance threshold to 60 points, with the additional performance threshold for exceptional performance remaining at 85 points.

Coverage for Opioid Treatment Programs

In a move the Academy backed, the 2020 MPFS establishes Medicare coverage for medication-assisted treatment for opioid use disorder (OUD).

CMS finalized the creation of new coding and payment for a monthly bundle of services for treatment of OUD that includes overall management, care coordination, individual and group psychotherapy, and substance use counseling, as well as an add-on code for additional counseling.

Outpatient Prospective Payment System

Also on November 1, 2019, CMS also issued “Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs” as a final rule with comment period.

The Academy had encouraged CMS in a September 19, 2019 letter to consider site-of-service payment parity from a broader perspective and to create incentives for services to be performed in the most cost-effective location, such as a physician’s office.

The final rule includes a policy that continues to eliminate differential payments between certain outpatient sites of service, completing a 2-year phase-in of the move to reduce unnecessary utilization in outpatient services by addressing payments for clinic visits furnished in the off-campus hospital outpatient setting. This could save Medicare beneficiaries $160 million and the Medicare program $650 million in 2020.

However, CMS did not finalize an Academy-backed proposal to require hospitals to disclose prices for all supplies, tests, and procedures. A separate final rule on the issue is expected in the future, the agency said.

Footnotes

  • AAFP News Staff

  • © 2020 Annals of Family Medicine, Inc.
PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 18 (1)
The Annals of Family Medicine: 18 (1)
Vol. 18, Issue 1
January/February 2020
  • Table of Contents
  • Index by author
  • Back Matter (PDF)
  • Front Matter (PDF)
  • In Brief
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
FEE SCHEDULE SUMMARY: AAFP ADVICE VISIBLE IN CMS FINAL RULE
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
16 + 0 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
FEE SCHEDULE SUMMARY: AAFP ADVICE VISIBLE IN CMS FINAL RULE
The Annals of Family Medicine Jan 2020, 18 (1) 84-85; DOI: 10.1370/afm.2508

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
FEE SCHEDULE SUMMARY: AAFP ADVICE VISIBLE IN CMS FINAL RULE
The Annals of Family Medicine Jan 2020, 18 (1) 84-85; DOI: 10.1370/afm.2508
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Evaluation and Management Services
    • Quality Payment Program
    • Coverage for Opioid Treatment Programs
    • Outpatient Prospective Payment System
    • Footnotes
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

Departments

  • What do Primary Care Patients Want?
  • Support for the WHO Resolution on Social Participation
  • STFM Announces New Point of Care Ultrasound Task Force and Initiative on POCUS Family Medicine Education
Show more Departments

Family Medicine Updates

  • What do Primary Care Patients Want?
  • Support for the WHO Resolution on Social Participation
  • STFM Announces New Point of Care Ultrasound Task Force and Initiative on POCUS Family Medicine Education
Show more Family Medicine Updates

Similar Articles

Content

  • Current Issue
  • Past Issues
  • Early Access
  • Plain-Language Summaries
  • Multimedia
  • Podcast
  • Articles by Type
  • Articles by Subject
  • Supplements
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Job Seekers
  • Media

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2025 Annals of Family Medicine