The Centers for Medicare & Medicaid Services (CMS) has released the 2021 Physician Fee Schedule, which will impact emergency medicine reimbursement significantly. The final rule was released Dec. 1, 2020, a month later than usual due to the public health emergency. More analysis will be included in a future issue, but here are points you need to know now to prepare for the rule, which took effect Jan. 1, 2021.

2021 RVUs Increase for ED E/M Services

Acting to protect the safety net, ACEP asked CMS to recognize the intensity of ED services and maintain the relativity between the ED evaluation and management (E/M) codes and the new patient office codes, which received increased values in 2021. Even though the ED codes received increases of about 5 percent for levels 1–4 in 2020, CMS has accepted our arguments and agreed to increase the ED relative value units (RVUs) for 99283–99285 again in 2021 (see Table 1).

Table 1: 2021 Increases to ED E/M Code Work RVUs

In addition to increasing the work RVUs, each year CMS tweaks the practice expense and professional liability insurance components of our RVUs, with the three components together making up our total RVUs for the year (see Table 2).

Table 2: 2021 ED E/M Code Total RVUs and Components

RVU= relative value units; PE=practice expense; PLI=professional liability insurance

2021 Conversion Factor Decrease

On Dec. 2, 2020, the 2021 Physician Fee Schedule published a conversion factor (payment per RVU) of $32.4085, a 10.2 percent decrease from the 2020 conversion factor of $36.0896. This significant decrease was due to the CMS decision to increase reimbursement for the office visit codes, a boon for urgent care facilities (which report using office codes). Importantly, the large increase in the office codes triggered a statutory requirement to decrease the conversion factor to maintain budget neutrality. ACEP has worked with Congress, highlighting the unprecedented strain emergency physician practices already face due to the ongoing COVID-19 pandemic.

Learn more about the 2021 Physician Fee Schedule at the Regs & Eggs blog by Jeffrey Davis, ACEP’s regulatory affairs director, at www.acep.org/2021-PFS-blog.

Congressional Action

On Dec. 21, 2020, Congress passed the Consolidated Appropriations Act of 2021, and President Donald Trump signed it into law on Dec. 27. The 5,593-page document that included several favorable adjustments to offset the 10.2 percent budget neutrality cuts, including:

• Delaying for three years the implementation of an add-on code (G2211) to office and other outpatient E/M services, which adds back about 3 percent to the conversion factor
• Authorizing new additional funds to support the conversion factor by 3.75 percent
• Delaying the 2 percent sequestration cuts for three months to allow time for the next Congress to address that issue on a more permanent basis

The above changes significantly improve emergency medicine’s outlook for 2021.