The Medicare Physician Fee Schedule (PFS) for 2021 was released on Dec. 1, 2020 and becomes effective on Jan. 1, 2021. The Centers for Medicare and Medicaid Services (CMS) estimates the overall impact of all Medicare changes on the allergy and immunology specialty to be an increase in Medicare revenues of 9% due largely to the higher payment for office visits and immunotherapy.
The Advocacy Council is developing a series of articles explaining different pieces of the PFS and how they apply to allergy/immunology practices that will be published over the next several weeks. Last week’s article discussed the complexity add-on code. In this article we discuss the 2021 relative value units (RVUs).
The College’s Advocacy Council developed a spreadsheet comparing reimbursement for 2021 physician work Relative Value Units (RVUs) to 2020 RVUs. You can also view specific RVUs for allergy codes or RVUs for all CPT codes. RVUs for each CPT code are published annually on the Centers for Medicare and Medicaid Services’ (CMS) website.
In the spreadsheet for all codes, of most interest to allergists are the physician work RVUs because this is what health systems and employers often use in their compensation formularies. Also note the total nonfacility RVUs for the code. This includes all three components – physician work, practice expense and professional liability insurance when performed in the physician office setting.
When a service is performed in the hospital setting (e.g., the hospital outpatient department or hospital-based clinic), the RVUs are reduced because the practice expense portion of the service is considered to be provided by the hospital (see the Total Facility RVUs column).
Due to budget neutrality requirements, the 2021 increases in evaluation and management (E/M) services are offset by a 10.2% reduction in the Medicare conversion factor, which results in overall payment decreases for a number of services, including some of the allergy testing codes.
To determine the exact amount of your Medicare reimbursement for 2021, you should check your Medicare Administrative Contractor’s website for the fee schedule applicable to your geographic area. This information should be available soon, if it is not already.
RVUs were developed by CMS about 30 years ago in response to congressional legislation to establish the relative value of physician services. The American Medical Association’s Relative Value Update Committee (RUC) proposes RVUs based on specialty society surveys and provides recommendations to CMS for consideration. CMS decides whether it will accept the RUC’s recommendations.
Be sure to watch the Advocacy Insider column next week as we discuss another area of the 2021 physician fee schedule. The Advocacy Council – we have you covered.