CMS Releases Final 2020 Physician Fee Schedule - 16% Increase for Endocrinology
November 1, 2019

The Physician Fee Schedule for CY 2021 includes an an overall 16 percent increase in E/M codes for Endocrinology – the most of any specialty. A record number of AACE members responded to an AACE “Action Alert” and sent comments to CMS in September in support of the higher valuations – thank you! Unfortunately CMS did NOT place FNA codes on the “potentially mis-valued” list, closing the door to a process to increase these codes, which were substantially reduced this year.

The final CY 2020 Physician Fee Schedule includes the following positive changes for E/M services starting January 1, 2021. The final rule:

  • Retain 5 levels of coding for established patients and reduce new patients to 4 levels
  • Add a new CPT code for extended office visit time
  • Require history and physical exams to be performed as medically appropriate and not require them for code level selection
  • Allow physicians to select their E/M level based on medical decision making or time
  • Implement a Medicare-specific add on code for office visits to describe the complexity associated with visits

In addition, the Final Rule makes several changes of particular benefit to endocrinologists:

  • The Final Rule adopts the AMA Relative Value Scale Update Committee (RUC) recommended values for the newly redefined E/M visit codes for CY 2021. This change increased the work RVU values for endocrinology significantly, and CMS has calculated that the average endocrinologist’s reimbursement will increase by approximately 11% due to this change.
  • The rule establishes a new “add-on code” (referred to as GPC1X in the Final Rule) designed to be used for non-procedural practices such as endocrinology, internal medicine and family medicine for complex patients beginning in CY 2021; CMS has previously stated that they expect endocrinologists to use this add-on code for about 90% of their visits. Use of this code accounts for a 5% overall positive increase in E/M allowed charges for endocrinologists beginning in CY 2021.
  • CMS created new codes for “Principal Care Management” services that would be rendered by specialists to patients with only a single serious and high-risk chronic condition. This would provide reimbursement for the management of patients with diabetes by endocrinologists who require expended telephone contacts to help manage their diabetes. This service is akin to Chronic Care Management services by primary care physicians to patients with multiple chronic conditions over a calendar month.

Table 120 of the final rule outlines the potential combined impact on these finalized payment policies on various specialties, with Endocrinology topping the list at 16%!

Additionally, AACE members are aware of substantial cuts in reimbursements for the new and revised fine needle aspiration codes for 2019. AACE advocated for you through letters to CMS and Congress opposing these cuts. Unfortunately CMS determined that no additional information was presented and is retaining a rarely used neonatal procedure as its comparator crosswalk for valuation. AACE will continue to advocate for a higher reimbursement for thyroid FNA codes.