January 07, 2021

ACR Prepares Updated MPFS Impact Tables

The Centers for Medicare and Medicaid Services (CMS) released an updated 2021 Medicare Physician Fee Schedule (MPFS) conversion factor in accordance with provisions included in the 2021 Consolidated Appropriations Act. The new conversion factor is $34.89, a 3.32% decrease from the 2020 conversion factor. The previously finalized conversion factor was a 10.2% decrease. The new conversion factor includes a 3.75% increase included in the legislation. In addition, the law directs CMS to suspend payment for the new code G2211, an add-on code for complex evaluation and management services, reducing the required budget neutrality adjustment. The combination of these two provisions resulted in the new conversion factor. Specific code level reimbursement changes vary based on relative value unit updates and formulary adjustments.

The American College of Radiology® (ACR®) has prepared code-level impact tables to enable members to determine impacts to their practices based on case mixes. The tables cover specific changes in reimbursement rates between calendar years 2019 and 2020 for each Current Procedural Terminology® (CPT®) code. The ACR analysis includes a spreadsheet for the 70,000 series CPT codes  and another spreadsheet for the non-70,000 CPT codes that are billed by radiologists, interventional radiologists and/or radiation oncologists.