Ophthalmology and Optometry Coding Alert

Plus: Telehealth may expand into next year.

In addition to the E/M code changes on the agenda for January, eye care practices should be aware of proposals in the Medicare Physician Fee Schedule (MPFS). If CMS’ proposals are finalized, eye care practices could face tighter budgets in the new year.

Context: On Aug. 3, CMS issued its Calendar Year (CY) 2021 MPFS proposed rule. The proposed rule was published in the Federal Register on Aug. 17. Check out a few highlights of how the proposal could impact GI practices.

• Expect a Post-COVID Telehealth Expansion. The Medicare telehealth expansion has been a real benefit to many eye care practices, and the proposal for 2021 indicates that an expanded list of telehealth services could be on the approved list through the end of next year.
• Get Ready for 2021 E/M Changes. Because some of the regulations and guidelines around office-based E/M codes will be updated for 2021, CMS is proposing a shift in the payment rates for some of these codes, which will lead to higher pay for them, if finalized.
• Prepare for a Major Conversion Factor Cutback. CMS aims to cut the conversion factor (CF) by 10.61 percent. According to the rule, the proposed CY 2021 PFS conversion factor is $32.26, a decrease of $3.83 from the current CF of $36.09, CMS indicates.
• Eye Care Practices Could See Pay Cuts. As in prior years, the fee schedule proposal includes a chart showing how the proposed changes could impact individual specialties. Although some specialties, such as pulmonologists, are expected to see more pay under the proposed rules, that’s not the case for eye care practices. According to the proposal, ophthalmologists could see a six percent drop in allowed charges after taking into account the combined impact of all proposed changes, while optometrists would see pay drop by five percent.

Comment period open: CMS will accept comments on the proposed rule until 5 p.m. on Oct. 5, 2020.

• Note: You can review the MPFS proposals at https://s3.amazonaws.com/public-inspection.federalregister.gov/2020-17127.pdf.