CMS Proposal Has Uneven Impact Across Specialties

Vertical: General
Author: JC Lupis
Date: August 2020

Surgeons are expressing their disappointment at the CMS’ recent proposed fee schedule for 2021, while primary care doctors are delighted. And both have good reason: an analysis of the estimated impact on total allowed charges by specialty shows a significant reduction for surgical specialties, while family practice enjoys a double-digit percentage increase and both pediatrics and internal medicine also experience a boost.

CMS has noted that for some specialties including family practice, increases are attributable in large part to increases in valuation for office/outpatient E/M visits – surely a welcome sign for primary care practices that have struggled under the weight of the COVID-19 pandemic.

Key Data Point

  • $32.26. The proposed 2021 conversion factor, representing a $3.83 decline from 2020’s conversion factor of $36.09.

Key Chart: Impact of CY 2021 Payment on Select Specialties

GHA-PFS-2021-Impact

Key Table: Impact of CY 2021 Payment on Select Procedures

GHA-PFS-Impact-Select-Codes-Chart