IMPORTANT Changes to 2020 RBRVS

Exec summary: changes to the RVUs this quarter include major fee increases in telemedicine visits and a big mid-year change to GPCI values.

A few times every year (as few as 4, as many as 6 or 7), CMS updates the RVU data files used to not only pay Medicare but set the fee schedules for the nearly all of the rest of the world.  Typically, these changes don't usually amount to much, but the release from May 1, which you can find here, has some very important updates for pediatricians to pay attention to.

First, there's a real change to the 99441-99443 codes, also known as "Phone e/m phys/qhp."  That's CMS-speak for when your doctor takes a phone call from a patient.   A 99441 is for a 5-10 minute call, 99442 for 11-20, and the 99443 is for 21-30.  Until this release, the RVU-to-$$ for these codes clocked in at approximately $14.44, $28.15, and $41.14 respectively.  In other words, a 30 minute phone call would generate $41 in revenue.  Further, the codes were marked with a status code of "N" - which means "N = Non-covered Services. These services are not covered by Medicare."  And if that doesn't make things clear, they have a special mark which indicates that the values are "Not Used for Medicare Payment."

You following so far?  Either way, let me roll to the first punchline.  

With the new RVU release, the telephone codes have been re-mapped so that a 99212 -> 99441, a 99213 -> 99442, and a 99214 -> 99443.  Or, in payment terms, $46.19, $76.15, and $110.43.  Those are improvements of 320%, 271%, and 268%, respectively.  A 21-30 minute phone call pays the same as a 99214.  

They didn't stop there.  The codes now have a status of "A" ("Active Code. These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy.") and the marker that indicates these codes aren't used for Medicare payment have been removed.

What's going on?  Simple - the Feds have announced big changes as a result of COVID.  

But that's not all.

They also restored the Work GPCI floor that had ended in 2019.  To quote the GPCI file itself, "The 1.0 Work GPCI floor expires on December 31, 2019, therefore the Work GPCIs for 2020 and 2021 do not reflect a 1.0 floor."  Yet, the new GPCI file resets the lowest Work values to 1.0.  This affects nearly 1/2 of the GPCI locales.  It's not a huge difference (perhaps 1.25% for MT, SD, AK, ID, MO, MI, etc.), 

Who does this affect?

Anyone whose contracts are pegged to the present RVU values should make sure to a) set their GPCI values correctly and b) make sure you are being paid properly for your telemedicine codes,   And if your payments are not pegged to the 2020 values, by all means reference the telemedicine codes and the link to the Fed policy above which makes it clear: phone codes are intended to match in-office E&M codes right now.