The work relative value units (RVUs) for office-based E/M codes 99202-99215 increased on Jan. 1 as part of the 2021 Medicare Physician Fee Schedule. (See the new values in the table below.) The increased values were part of a broader effort to reform E/M coding and reduce the documentation burden.
| Code | 2020 work RVUs | 2021 work RVUs | % change | 2021 Medicare payment amount |
|---|---|---|---|---|
99201 | 0.48 | n/a (code deleted | n/a | n/a |
99202 | 0.93 | 0.93 | 0% | $74.32 |
99203 | 1.42 | 1.6 | 12.6% | $114.44 |
| 99204 | 2.43 | 2.6 | 7% | $172.01 |
| 99205 | 3.17 | 3.5 | 10.4% | $227.13 |
| 99211 | 0.18 | 0.18 | 0% | $23.73 |
| 99212 | 0.48 | 0.7 | 45.8% | $36.56 |
| 99213 | 0.97 | 1.3 | 34% | $93.51 |
| 99214 | 1.5 | 1.92 | 28% | $132.93 |
| 99215 | 2.1 | 2.8 | 32.7% | $185.96 |
How the increased RVUs will affect family physicians depends on several factors, including their payer contracts and their compensation model.
For Medicare, total RVUs (comprised of work, practice expense, and malpractice RVUs) are multiplied by the year’s conversion factor ($34.89 for 2021) to determine the payment allowance for each code. Overall, Medicare payments for family physicians are expected to increase more than 10% due to the E/M revaluation and other changes.
For private payers, the Medicare physician fee schedule often forms the basis of their own fee schedules, but they may use a prior year’s fee schedule or pay only a negotiated percentage of the Medicare physician fee schedule. If private payers do not automatically adjust their fees based on the updated RVUs, physicians may need to renegotiate these contracts. Physicians in solo and independent practice should check with their private payers on this issue. (See “Questions to Ask Private Payers.”)
For employed physicians, compensation usually takes the form of a base salary supplemented with an incentive/productivity bonus based on factors such as work RVUs, collections, and quality. If RVUs make up a significant portion of your compensation formula, talk to your administrator about how the increased values for office visit E/M codes will affect your pay and whether productivity targets will change. (See “Talking Points for Employed Physicians.”)
Read about additional payment and coding changes in the full article in FPM: “The 2021 Medicare Payment and CPT Coding Update.”
Posted on Jan 18, 2021 by FPM Editors
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Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.
I am a seasoned healthcare finance expert with a deep understanding of medical coding and reimbursem*nt systems. Throughout my career, I've actively engaged in the complexities of healthcare billing and reimbursem*nt, especially in relation to the Medicare Physician Fee Schedule and Evaluation and Management (E/M) coding. I've closely followed industry updates and policy changes to stay abreast of the evolving landscape.
In the provided article, the focus is on the changes to the work relative value units (RVUs) for office-based E/M codes 99202-99215 in the 2021 Medicare Physician Fee Schedule. These changes aim to streamline E/M coding and alleviate the documentation burden for healthcare professionals. Let's break down the key concepts and provide insights into the relevant information:
-
Work RVUs (Relative Value Units):
- RVUs are a crucial component in determining the reimbursem*nt for medical services.
- The table presents the 2020 and 2021 work RVUs for E/M codes 99202-99215, highlighting the percentage change for each code.
-
Medicare Physician Fee Schedule:
- The Medicare Physician Fee Schedule plays a pivotal role in setting the reimbursem*nt rates for various medical services.
- Total RVUs (comprising work, practice expense, and malpractice RVUs) are multiplied by the conversion factor to calculate the payment allowance for each code.
-
Impact on Family Physicians:
- The article mentions that the effect of increased RVUs on family physicians depends on factors such as payer contracts and compensation models.
- For Medicare, it is anticipated that payments to family physicians will increase by more than 10% due to E/M revaluation and other changes.
-
Private Payers and Fee Schedules:
- Private payers often base their fee schedules on the Medicare physician fee schedule.
- Physicians are advised to check with private payers to ensure that fees are adjusted according to updated RVUs. Negotiations may be necessary if adjustments are not automatic.
-
Compensation Models for Physicians:
- Compensation for employed physicians typically includes a base salary and incentives/productivity bonuses.
- Physicians are encouraged to discuss with administrators how the increased values for E/M codes will impact their pay and whether productivity targets will be adjusted.
-
Additional Changes and Updates:
- The article suggests referring to the full article in Family Practice Management (FPM) for comprehensive information on the 2021 Medicare Payment and CPT Coding Update.
In conclusion, the 2021 changes in work RVUs for E/M codes represent a significant shift in reimbursem*nt structures, particularly affecting family physicians. It is essential for healthcare professionals to stay informed about these changes, assess their individual situations, and engage with payers to ensure fair compensation in light of the revised RVUs.
