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.

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

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