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Updates to the 2021 Medicare Physician Fee Schedule, Anesthesia Conversion Factor

Updates to the 2021 Medicare Physician Fee Schedule, Anesthesia Conversion Factor

The 2020 Coronavirus Relief & Omnibus Agreement, a COVID-19 relief bill that was approved in late December and is second in size only to the CARES Act passed last spring, provided much-needed relief for anesthesiologists, especially through updates to the 2021 Medicare Physician Fee Schedule. 

Two different provisions in the recent legislation led to changes in both the general conversion factor and the anesthesia conversion factor for 2021. Those changes include:

  • A three-year delay of a new add-on code for “inherent complexity” (G2211) that providers could bill in addition to office and outpatient E/M visits.
  • The 3.75 percent increase to the Medicare conversion factor for 2021 to help offset the steep cuts that will still exist because of changes to the office and outpatient E/M visits.

As a result, the original 2021 anesthesia conversion factor of $20.05, a 10 percent decrease from 2020, was recalculated. Now, the anesthesia conversion factor for 2021 is $21.56, or only a 3 percent decrease from 2020.

WPS-GHA, Indiana’s Medicare Administrative Contractor, recently released the locality adjusted conversion factors, and for Indiana, the recalculated 2021 conversion factor is $20.52, up from the original 2021 factor of $18.29, but still down from the 2020 factor of $21.11.

As well, the recalculated general conversion factor for 2021 is $34.89, up from the originally published $32.41 and only a 3 percent decrease (rather than approximately 10 percent) from the 2020 PFS conversion factor of $36.09.

WPS-GHA also published the full recalculated (and downloadable) fee schedule for the Indiana locality on its website.

In addition to the delay of G2211 and the increases to the Medicare conversion factor, the recent legislation also mandates an extension to the temporary suspension of the 2 percent Medicare sequestration for another three months, which will provide some additional relief for physicians.

The American Society of Anesthesiologists (ASA) called the update “an improvement, but still entirely inadequate for a specialty already hampered with a flawed payment rate, whose members are caring for COVID-19 patients on the frontlines of the pandemic.”

“One of the few things all Americans can agree upon is that all those physicians putting their own wellbeing at risk working in hospitals are the true heroes of this public health crisis,” said ASA President Beverly K. Philip, M.D., FACA, FASA. “Cuts to physicians providing care to Medicare patients especially at this time is just not right.” 

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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