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Medicare Physician Fee Schedule 2020: E&M Saga Continues

February 27, 2020

By Natalie Cohen, MBA, MHA

Medicare Physician Fee Schedule 2020: E&M Saga Continues
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The 2020 Medicare Physician Fee Schedule Final Rule is being promoted by CMS as a vehicle to reduce clinical burden, ensure appropriate payment for Medicare Part B providers and enable them to provide higher quality, patient-driven healthcare. With only a $0.05 change in the conversion factor, the most discussed item in the Rule is the turnaround in evaluation and management (E&M) coding slated to go into effect in 2021. The current Rule abandons the proposed change to the 2019 Final Rule that would result in a “collapsing” of the widely used office and other outpatient evaluation and management CPT codes (99201-99215). Below are highlights of the current Rule:

  1. The changes to the E&M codes will go into effect in 2021

  2. The changes in the 2019 Final Rule were reversed with the 2020 Rule. There will not be a “collapse of the codes”. They will retain 5 levels of coding for established patients and reduce the number of codes to 4 for new patients by deleting code 99201.

  3. Other E&M changes include:

  • The revision of times and Medical Decision Making (MDM) requirements for all codes
  • An increase in payment for E&M visits 
  • History and medical exams are only required when medically appropriate
  • Medical Decision Making or time spent with the patient the day of can be used as the basis to select a code level
  • Prolonged services code can be used in instances when a level five office/outpatient visit is exceeded by 15 minutes or more (approximate payment $22)
  • New add-on code (G-code) for office/outpatient E&M visits will be available for primary care and non-procedural specialty care describing the work associated with visits that are part of ongoing, comprehensive primary care and/or visits that are part of ongoing care related to a patient’s single, serious or complex chronic condition (approximate payment $15)

Please refer to the CPT® Codebook for the guidelines and documentation requirements. Always check with your biller or certified coder before implementing any coding or documentation changes.

Table 120 in the 2020 Final Rule displays estimated specialty level impacts of the finalized E&M payment and coding policies on 2021 reimbursements. Some of the most significantly impacted specialties are shown below.

Revenue cycle management consists of effective billing, payment and collection policies and procedures. By managing the revenue cycle process from the outset (at the time the first appointment is made), providers can create greater billing and payment transparency and minimize any post treatment financial surprises. Effective revenue cycle management can help mitigate your malpractice and compliance risks. 

If you are interested in learning more about Practice Solutions or would like assistance with the Quality Payment Program or revenue cycle management information, contact LAMMICO Practice Management Specialist, Natalie Cohen, MBA, MHA, at 504.841.2727 or

This content is accurate as of February 27, 2020. 

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