Physician Fee Schedule for 2019 Includes Changes to Evaluation-and-Management Services

The 2019 Medicare physician fee schedule final rule included several changes when it comes to payment for evaluation-and-management (E/M) services.

Physicians should make note about three things in next year’s fee schedule from the Centers for Medicare & Medicaid Services (CMS).

  • CMS has postponed the E/M coding “collapse” for at least two years. CMS will postpone its proposal to collapse payment rates for four E/M office visit services into a single blended rate. The AMA advised CMS the proposal could create unintended consequences for specialties that treat the sickest patients and for physicians who provide comprehensive primary care.

CMS also announced it would consider the recommendations of the AMA-convened Current Procedural Terminology (CPT®)/Relative Value Scale Update Committee (RUC) Workgroup.

As members of various specialties, the panel members use the office visit codes to describe and bill for services provided to Medicare patients. The group is analyzing these issues and plans to offer solutions to CMS for future implementation.

The work group seeks to build consensus around modernizing the office and outpatient E/M CPT codes to simplify the documentation requirements and better focus code selection around medical decision-making and physician time.

The delay in implementation will provide the opportunity for CMS to examine the work done by the AMA and the CPT Editorial Panel, as well as other stakeholders.

  • Proposed same-day-service pay cut will not be implemented. CMS has dropped its proposal to chop in half payments for office visits that occur on the same day as a procedure furnished by the same physician or another physician in the same practice.

  • New documentation rules cut physician administrative burden. CMS followed AMA suggestions as well as some 170 other medical groups (including CSMS) in a letter sent to CMS Administrator Seema Verma.

Specifically, physicians will not have to re-document elements of a patient’s medical history and physical exam. Instead, documentation will focus on patients’ medical history during the interval since the previous visit. Also gone is a requirement that physicians re-document information recorded by their staff or by the patient. In addition, a requirement to document the medical necessity of furnishing a home visit rather than an office visit has been eliminated.

Physicians participating in CTHealthLink, the physician-led health information exchange, may improve patient care coordination and transitions of care by accessing a list of facilities where the patient was seen, admit and discharge dates, lab results, procedures and diagnoses, current and past medications, allergies, chief complaint, visit notes, operation notes and the patients’ primary care providers.

To learn more about how CTHealthLink can help your organization visit or call CSMS EVP/CEO Matthew Katz, 203.641.7046.