ED Coding and Reimbursement Alert

Question: A few months ago, you published an article noting that CMS was considering raising the relative value units for the ED E/M codes. When will they make a final decision?

Codify Subscriber

Answer: CMS released its 2020 Medicare Physician Fee Schedule Final Rule on November 15, which confirmed the following updates to the work RVUs of the first four emergency department E/M codes (99281-99284). That change, coupled with an increase in the conversion factor to 36.0896 will create the following payment amount changes to your ED E/M codes effective January 1:

You’ll note that although the work RVUs for 99285 did not change this year, the payment will rise slightly due to the updated conversion factor of $36.09.

In a change from recent years, the final rule does not include a work Geographic Practice Cost Index (GPCI) floor of 1.00, so there may be additional reductions in payment if your GPCI area pays less than 1.00 in 2020. Congress may yet act to restore the minimum work GPCI floor, so stay tuned.

Resource: To read the Federal Register, which contains the 2020 Medicare Physician Fee Schedule Final Rule, visit
 https://www.federalregister.gov/documents/2019/11/15/2019-24086/medicare-program-cy-2020-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other.