In December 2020 the Centers for Medicare and Medicaid Services (CMS) deployed significant changes to evaluation and management (E&M) codes and the 2021 conversion factor (CF). Additionally, it is expected that CMS will, minimally, further reduce the CF for 2022 in order to meet certain Congressionally required budgetary mandates.
Many clinician compensation plans are tied to work relative value units (wRVU). While the 2021 changes may alter clinic and health system spend on clinicians whose compensation is tied to wRVUs, the change in the CF may alter expected reimbursements. The remainder of this article will examine CMS’s changes to wRVUs and the CF and the impact those changes have on one code – 99203.
E&M Reimbursement Rates
Generally, payment for an E&M visit is calculated thusly:
{[(wRVU x wGPCI) + (peRVU x peGPCI) + (mpRVU x mpGPCI)] x CF} = payment
In the above calculation, wRVU is the work value of the procedure, peRVU is the theoretical practice expense…