2021 Medicare Physician Fee Schedule Slashes Lab Reimbursements 5% but Provides Some PAMA Relief
On Aug. 3, CMS released the proposed Medicare Physician Fee Schedule (PFS) rule for 2021. Bottom line on top: The agency is slashing lab reimbursement rates. Here are the four key takeaways for labs. Note that the deadline to comment is Oct. 5. Overall Physician Payment Rates CMS is proposing to reduce the conversion factor it uses to calculate the PFS rate from $36.09 to $32.26. This whopping 10.6 percent cut is necessary because CMS is significantly increasing E/M code reimbursement rates in 2021 and, by law, the agency is required to maintain budget neutrality by implementing decreases to offset increases. Impact on Labs and Pathologists The reduced conversion factor and other proposed policy changes will reduce overall payments to independent labs by approximately 5 percent, and to pathologists by roughly 9 percent, according to CMS’ projections. By contrast, the 2020 PFS increased overall lab payments by 1 percent payments for pathology even with 2019 levels .Among the largest scheduled cuts is to the professional component of pathology tissue examinations, which is slated to drop 12 percent to $34.52 to $39.34. One-Year Delay in PAMA Reporting The news isn’t all bad. Delivering on promises made during the March CARES Act […]
- Overall Physician Payment Rates
- Impact on Labs and Pathologists
- One-Year Delay in PAMA Reporting
- PAMA Pricing Relief
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