CMS Releases Final 2020 Medicare PFS, HOPPS

Cardiology Magazine Image

The Centers for Medicare and Medicaid Services (CMS) has released the 2020 Medicare Physician Fee Schedule (PFS) final rule addressing Medicare payment and quality provisions for physicians in 2020.

Under the proposal, physicians will see a virtually flat conversion factor on Jan. 1, 2020, going from $36.04 to $36.09. CMS estimates that the physician rule will maintain overall payment to cardiologists from 2019 to 2020 through updates to work, practice expense and malpractice RVUs. This estimate is based on the entire cardiology profession and can vary widely depending on the mix of services provided in a practice.

Of particular note for cardiology, the 2020 rule includes the finalization of a proposal supported by the College that will add codes describing angioplasty and PCI to the Ambulatory Surgery Center Covered Procedures list for 2020. Additionally, thanks to significant advocacy efforts by ACC and partner cardiovascular societies, CMS has deferred dramatic proposed cuts to myocardial PET.

Additional details and highlights include:

  • The significant payment cuts to myocardial PET were not finalized. CMS revised the inputs used to calculate technical component payment for myocardial PET services. Rather than facing technical component cuts as high as 80 percent, the technical component of myocardial PET services will continue to be paid contractor pricing in 2020 while additional information about direct practice expense inputs is developed for future rulemaking. ACC and others will provide additional information as feasible to further inform rate setting. CMS also altered its proposal on physician work, adopting AMA Relative Value Scale Update Committee (RUC) recommendations rather than proposed lower alternatives.
  • Proposed changes to evaluation and management (E/M) payment were both altered and/or delayed until 2021 in the 2019 final rule last November. Under the 2020 rule, CMS finalized revisions to E/M documentation and payment policies.
    • Walking back a prior plan to pay a blended rate for level 2-4 visits, CMS has adopted revised E/M code definitions developed by the AMA CPT Editorial Panel starting Jan. 1, 2021. Members from across the House of Medicine worked together throughout the process to address concerns about documentation burden in a manner that was less disruptive and correctly discerned differences in levels of E/M services.
    • The revised coding definitions is paired with a decision to pay for each level of service rather than use a blended rate.
    • Incorporating recommendations from the AMA RUC, CMS adopted revised work and practice expense (PE) inputs for E/M services.
  • CMS made no changes regarding implementation of the mandate requiring that clinicians consult appropriate use criteria (AUC) through a qualified clinical decision support mechanism (CDSM) starting Jan. 1, 2020, when ordering advanced imaging services (i.e., SPECT/PET MPI, CT and MR). Additional resources are available at ACC.org/AUC.
  • CMS made updates to work and/or PE values for codes describing transcatheter aortic valve replacement (TAVR), remote loop recorder interrogation and remote cardiac monitor interrogation, noncoronary IVUS, and abdominal aortography. More detail will be available after CMS posts supporting data tables.
  • Work and or PE values for new/revised codes describing self-measured blood pressure monitoring, ambulatory blood pressure monitoring, remote physiologic monitoring, pericardiocentesis and pericardial drainage, myocardial strain imaging and myocardial PET, were included in the final rule.

2020 QPP Highlights

The Final 2020 Medicare Physician Fee Schedule also includes important updates to the Quality Payment Program. Highlights include:

  • Increase in the performance threshold from 30 points in 2019 to 45 points in 2020.
  • Additional increase for exceptional performance to 85 points in 2020.
  • The weights associated with the Quality, Cost, Promoting Interoperability, and the Improvement Activities categories did not change from 2019.
  • Finalized the revised total per capita cost (TPCC) and the Medicare Spending Per Beneficiary measures.
  • Increase in the data completeness threshold for the quality data that clinicians submit to 70 percent.
  • Increase in the threshold for clinicians who complete or participate in the Improvement Activity for group reporting.
  • Updates to requirements for Qualified Clinical Data Registry (QCDR) measures and the services that third-party intermediaries must provide (beginning with the 2021 performance period).
  • Maintaining low-volume threshold, eligible clinician types, MIPS performance periods, CEHRT requirements, and small practice bonus points.
  • Initial aspects of the MIPS Value Pathways (MVPs) will commence in the 2021 MIPS performance period, including the extent of first year implementation or the feasibility of an initial pilot. CMS envisions an initial uniform set of Promoting Interoperability measures in each MVP and will consider customizing MVP Promoting Interoperability measures in future years.

Visit the ACC's QPP hub for additional information and resources at ACC.org/QPP.

HOPPS Highlights

In tandem with the final PFS rule, CMS also released its 2020 Hospital Outpatient Prospective Payment System (HOPPS) final rule.The outpatient rule indicates a 2.6 percent payment update for hospitals and other proposals. Highlights include:

  • CPT codes describing angioplasty and stent PCI were added to the Ambulatory Surgery Center Covered Procedures list for 2020, reflecting feedback of ACC and other stakeholders.
  • CMS finalized the operational implementation schedule for prior authorization for July 1, 2020 for certain Outpatient Department Services. Several vein ablation services provided to cardiovascular patients were included on this list.
  • Rather than finalize an earlier proposal requiring hospitals to publicize a list of standard charges, CMS will summarize and respond to concerns about hospitals price transparency for "shoppable" services in forthcoming final rules.
  • CMS finalized its proposed APC assignment of cardiac CT angiography and cardiac MRI despite comments indicating these rates undervalue the resources needed to provide these services. APC assignment of FFRCT was altered from APC 1509 with a payment rate of $750.50 to APC 1511 with a payment rate of $950.50.
  • While navigating a lawsuit over this policy, CMS finalized the second of a two-year phase to cap payment for off-campus hospital clinic visits at a rate equivalent to the PFS rate.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Pericardial Disease, Aortic Surgery, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: ACC Publications, Cardiology Magazine, ACC Advocacy, Relative Value Scales, Blood Pressure Monitoring, Ambulatory, Transcatheter Aortic Valve Replacement, Centers for Medicare and Medicaid Services (U.S.), Blood Pressure, Decision Support Systems, Clinical, Pericardiocentesis, Aortography, Ambulatory Surgical Procedures, Area Under Curve, Fee Schedules, Medicare, Medicaid, Health Expenditures, Malpractice, Angioplasty, Percutaneous Coronary Intervention, Tomography, Tomography, X-Ray


< Back to Listings