2021 MPFS Update & Consolidated Appropriations Act of 2021 for ED

February 21, 2021

Previously, the changes in the 2021 Medicare Physician Fee Schedule (MPFS) writ large were described; these are several MPFS updates that are specific to Emergency Medicine (ED) and then further changes that were made in the most recent COVID relief and budget bill.

CMS finalized the proposed increases in the ED E/M codes for 2021 as follows:

CPT Code2021 W-RVU2020 W-RVUPercentage Increase

Key Takeaways:

  • The expected cut in the conversion factor (CF) did not occur because of the provisions of the Consolidated Appropriations Act of 2021 (CAA) (see discussion below). Therefore, we expect that most ED groups will see a 0 to +1% increase in Medicare reimbursements in 2021.
  • Based in part on ACEP and EDPMA advocacy, CMS revised its proposed rule and has included reimbursement for all five (5) E/M levels for telehealth (T/H) through the end of 2021.
  • During the pendency of the public health emergency (PHE) (the current declaration ends on Jan. 23, 2021 and is expected to be extended), CMS will permit teaching physicians to “directly supervise” residents using T/H.
  • Again, both ACEP and EDPMA advocated for CMS to finalize its proposal to permit EM to use an add on code—worth 1.3 W-RVUs (between a Level II and Level III E/M service—when providing medication assisted treatment (MAT) in the ED in 2021 and beyond. The add on code is reimbursement for the assessment, referral of care, follow up after treatment begins and arranging access to support services.
  • CMS finalized its proposal to allow nurse practitioners (NPs) and physician assistants (PAs) to supervise the performance of diagnostic tests in addition to physicians.

The Consolidated Appropriations Act of 2021 (CAA) (a.k.a, COVID relief and budget package) was signed into law on Dec. 27, 2020—several important changes were made that impact the MPFS for 2021.

Click below to access the document containing several frequently asked questions (FAQs) regarding the CAA and MPFS. 

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