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November 13, 2019


CMS Finalizes Revised E/M CPT® Codes for Office/Outpatient Visits

The Centers for Medicare and Medicaid Services released the 2020 Medicare Physician Fee Schedule and Quality Payment Program final rule on Nov. 1. This rule finalized the evaluation and management (E/M) code changes that were proposed in July 2019. The revised codes will go into effect January 2021, which gives IDSA ample time to create educational resources to assist our members with the coding changes.

The American Medical Association CPT® Editorial Panel convened a workgroup in November 2018 to revise the descriptors and documentation requirements for the E/M office visits, and revised codes were surveyed through the RUC valuation process in April of this year. CMS then proposed those changes in the rule released in July. IDSA was supportive of revised E/M codes and the associated work relative value units. IDSA has long been an advocate for increasing the value of E/M codes, and we see this as a positive change. IDSA staff and members of the Clinical Affairs Committee continue to advocate for the value of the ID physician and working with AMA and other stakeholders helps us show the value our members provide to their patients and to the health care system.

In addition to the revised office visit codes, CMS created and subsequently valued a new code to describe complex patient care. The new code may be reported as an add-on code only with office/outpatient E/M visits, to describe the additional time and resources needed to provide care to a patient with a single, serious, or complex chronic condition. IDSA was also in support of this new code and submitted comments to CMS.

The rule also finalizes other policies that pertain to care management services, medical record documentation, scope of practice and open payments, among many other topics. Read the 2020 MPFS Final Rule  and a Fact Sheet on the changes.

In conjunction with the MPFS final rule, CMS published the 2020 Quality Payment Program updates. Most notable was the creation of the MIPS Value Pathways with an implementation date of January 2021. The goal of this new program is to create a more streamlined, less burdensome pathway for physicians to participate in the Merit-based Incentive Payment System. CMS has not finalized specifics of the program but noted that it will be working with medical specialty societies to create the framework of the MVPs. IDSA staff will be following this closely and will provide input as needed as the program is developed. For more information read the 2020 Quality Payment Program Final Rule Overview Fact Sheet.

IDSA staff continue to follow and comment on the payment policy issues that affect our members. Please contact Kay Moyer, IDSA program officer, clinical affairs, at with questions.


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