Radiology Cuts Due to Medicare Evaluation and Management Changes: What You Need to Know

The American College of Radiology® (ACR®) and more than 50 other provider organizations are urging Congress to waive the budget neutrality requirement for evaluation and management (E/M) CPT® code increases mandated by the CY 2021 Medicare Physician Fee Schedule.

Application of budget neutrality and resulting cuts to pay for E/M increases will slash radiology payments by 11 percent — starting as early as Jan. 1, 2021. The new policy hurts physicians who do not often bill E/M services. With COVID-19’s financial impact on practices, this CMS action will harm providers and patient access to care

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ACR Efforts to Counter Evaluation and Management (E/M) Coding Changes. Click the image to view a larger version.

Evaluation and Management Timeline medium size image

Tell your member of Congress to support the budget neutrality waiver for these Medicare changes!

ACR Resources

MPFS Impact Tables at the Code Level
ACR® impact tables show the payment rates for radiology and radiation oncology services for CY 2020 compared to the 2021 proposed rates. One of the main factors contributing to the decrease is the decrease in the conversion factor to maintain budget neutrality due to updates to the office/outpatient E/M services for 2021.

ACR Provides Detailed Radiology-Specific Summary of the MPFS Proposed Rule
CMS reiterated its decision in the 2020 final rule to move forward with adoption of a new coding structure for the office/outpatient E/M codes as recommended by the American Medical Association (AMA) and the associated increased valuations of these E/M services.

E/M News

Congress Must Act to Stop Cuts Threatening Specialty Physicians
Howard B. Fleishon, MD, MMM, FACR, chair of the American College of Radiology Board of Chancellors, explains how ill-timed Medicare evaluation and management coding changes may force many physician practices, already reeling from COVID-19’s financial impact, out of business.

Congressman Rush Requests E/M Budget Neutrality Waiver
Rep. Bobby Rush (D-IL) and 92 House colleagues sent a bipartisan letter to House leadership asking for a two-year waiver of budget neutrality to be included in any relevant upcoming legislation to avert the impending reductions associated with implementing the Centers for Medicare and Medicaid Services (CMS) 2021 evaluation and management (E/M) policy.

Modern Healthcare: ACR Calls Payment Cuts Due to Medicare E/M Changes “Unacceptable”
In a recent Modern Healthcare article, ACR called these E/M cuts “unacceptable” and warned that "An 11 percent across-the-board cut will seriously threaten radiology's ability to ensure patients have access to the high quality of care they rightfully deserve." (Subscription may be required)