ACR Applauds E/M Coding Changes, Telehealth Expansion in CY 2021 Physician Fee Schedule Proposed Rule Save

The American College of Rheumatology (ACR) today applauded the Centers for Medicare and Medicaid Services (CMS) for taking steps to appropriately value cognitive care and expand telehealth access in its CY 2021 Physician Fee Schedule (PFS) Proposed Rule.

“The ACR commends CMS for recognizing the historic undervaluing of the services provided by rheumatologists and other cognitive care providers, and for taking steps in this proposed rule to more appropriately reimburse the complex care they provide to Medicare patients,” said ACR President, Ellen Gravallese, MD. “This is good news for the 54 million Americans who live with rheumatic disease – many of whom are current Medicare beneficiaries or will enter the Medicare system one day – and will help to ensure they continue to receive the healthcare services they need and deserve.”

Evaluation and management (E/M) services provided by cognitive specialists, including rheumatologists, have historically been undervalued by Medicare. A 2018 report from the Medicare Payment and Advisory Commission (MedPAC) found that healthcare services billed under E/M codes – which include examinations, disease diagnosis, risk assessments, and care coordination – are grossly under-compensated, creating significant patient access issues and contributing to workforce shortages.

If implemented as written, the 2021 PFS proposed rule will address these historic issues and increase patient access by improving office visit payments and expanding telehealth services.