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Action Alerts

Urge Your Members of Congress to Support CMS’ CY 2021 E/M Proposal

On August 3, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule (MPFS) proposed rule for calendar year (CY) 2021, which includes the outpatient evaluation and management (E/M) policy finalized in last year’s MPFS for implementation on January 1, 2021. Last year, CMS increased the valuations for outpatient E/M services; developed new documentation requirements that allow providers to bill by time or medical decision making; and created two new add-on codes – one for additional complexity, GPC1X, and another for prolonged time on the day of service, 99XXX.

These revisions to the outpatient E/M services are the first significant changes to their valuation and documentation requirements since the resource-based relative value scale was implemented. However, CMS has proposed in the CY 2021 rule a 10.6 percent cut to the conversion factor as a result of the outpatient E/M policy and other policies to maintain budget neutrality. Since the release of the proposed rule, many stakeholders are urging CMS and Congress to prevent the cut to the conversion factor, which is resulting in significant reimbursement cuts for some specialties. While we are sympathetic to the payment cuts of other physician specialties, particularly during the ongoing COVID-19 pandemic, the increased values for the E/M codes are a long overdue first step toward appropriately recognizing the value of primary and medical specialty care, like that delivered by American Society of Hematology (ASH) members. Therefore, it is critical for ASH members to act now to ensure the E/M policy is implemented without change on January 1, 2021.

Simply fill out the form below and click “send email” to quickly send a message urging your members of Congress to contact CMS to express their support for the CY 2021 E/M documentation and payment changes as finalized and urge that they be implemented on January 1, 2021.