Healio Special Report: Health Care and Politics

Healio Special Report: Health Care and Politics

August 07, 2020
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Fee schedule for nephrologists would boost payments for dialysis, cut payment for access

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Proposed changes to the Medicare Fee Schedule for 2021 would boost fees for office visits and monthly capitated payments for nephrologists.

The proposed rule for the 2021 Medicare Fee Schedule was released on Aug. 4, and “there was significant positive news for nephrology,” Robert Blaser, director of public policy for the Renal Physicians Association, wrote in a memo to members.

Monthly capitated payment
Reference: Renal Physicians Association

CMS increases relative value units (RVUs) for the outpatient dialysis codes “based on increases in the underlying evaluation and management (E&M) building block codes over the past fifteen years,” Blaser wrote. “Every code in the code family, adult and pediatric, in-center and home, monthly and daily, is increased.”

The proposed rule covers CPT codes 90960 through CPT code 90970, with increases ranging from 13% to 29% for the monthly capitated payment (MCP). The code covering all four visits to dialysis patients per month, for example, would increase from $291 in 2020 to $337 in 2021, Blaser wrote. Office visit codes also receive an increase in payment under the proposed rule.

The changes would result in an average 6% increase in payments to nephrologists.

Robert Blaser

“RPA believes that adjustment of the family of monthly ESRD service codes based on the increase in underlying E&M services is long overdue,” Blaser wrote.

Even with those increases in payments, CMS did propose to cut the conversion factor to account for budget neutrality; the proposed CY 2021 PFS conversion factor is projected to be $32.26, a decrease of $3.83 from the CY 2020 PFS conversion factor of $36.09, Blaser wrote.

That change in the conversion factor (CF) will impact payments for inpatient dialysis services and interventional access procedures, Blaser wrote. “With regard to inpatient dialysis services, all four service codes (CPT codes 90935, 90937, 90945, and 90947) will experience incremental increases in value for 2021, but with the reduction in the CF are proposed to have a substantial reduction in payment for 2021; for example, CPT code 90935, hemodialysis, single evaluation, is slated to have a median national payment of $67.74 for 2021, as opposed to $75.06 for 2020.

“On the interventional side, the large volume dialysis circuit codes will also be adversely affected by the conversion factor reduction. CPT codes 36902 and 36905 (both balloon angioplasty services) each have RVU increases of 7% and 8%, respectively, but because of the CF cut will experience payment reductions of 4% and 3%, respectively.”

Comments on the proposed rule must be submitted to CMS by Oct. 4, 2020.