2020 Medicare Physician Fee Schedule & Quality Payment Program Proposed Rule Released

On July 29, The Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2020 Physician Fee Schedule (MPFS) proposed rule. This major proposed rule addresses changes to the Medicare physician fee schedule and other Medicare Part B payment policies, including the Quality Payment Program (QPP).

CMS proposes to adopt revisions in evaluation and management (E&M) visit code definitions developed by the AMA CPT editorial panel. If finalized, these changes would begin in 2021. The proposal calls for retaining five levels of coding for established patients, and reducing the number of levels to four for new patients (eliminating 99201); eliminating history and physical as determinants for E/M code selection and allowing clinicians to choose the E/M visit level based on either medical decision making or time. A new add-on code for prolonged services and for primary care/non-procedural specialty care is also proposed. Changes to the Quality Payment Program include an increase in the cost component of the Merit- based Incentive Program (MIPS) score to 20% and the inclusion of an episode-based cost measure on lumpectomy and mastectomy. In addition to proposed updates (MIPS) and Alternative Payment Models (APMs), CMS is requesting feedback on a new framework for future MIPS participation called MIPS Value Pathways. This new pathway would seek to align measures around conditions and include risk adjustment to prepare MIPS participants for future participation in APM’s. The Society is evaluating these and other proposals and their impact on breast surgery and plans to submit comments to CMS.

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