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E/M Changes

Evaluation and Management Changes as of January 2021

Revisions to the Evaluation and Management (E/M) office visit CPT codes take effect on January 1, 2021. The goal of the revisions is to address some of the issues related to administrative burden for physicians in the United States. The American Medical Association (AMA) has developed several resources to help physicians prepare for E/M changes beginning January 1, 2021. These free tools are located at the AMA website and also included below:

AMA E/M medical decision-making chart 

AMA E/M training module

Practice management checklist


AUGS Calls on Congressional Leaders to Avert Medicare Physician Payment Cuts

AUGS joined 52 other surgical and medical specialty societies in sending a letter to House Speaker Nancy Pelosi and Senate Majority Leader Mitch McConnell urging Congress to waive the budget neutrality requirements stipulated under the Social Security Act for the finalized Evaluation and Management (E/M) code proposal slated for implementation on January 1, 2021.  Congressional action to include a waiver in any forthcoming legislative package will provide a critical reprieve for a broad scope of health care providers facing substantial payment reductions in the coming months due to the E/M code changes.

As reported in previous AUGS publications, positive payment adjustments for E/M services provided in office and outpatient settings were finalized as part of the Calendar Year 2020 Medicare Physician Fee Schedule. However, the Centers for Medicare and Medicaid Services (CMS) decided not to provide the positive updates to payments for E/M services if the services are billed as part of a global surgical package. This provision unfairly targets surgeons and conflicts with current law that prohibits Medicare from making payments to physicians for the same work but at different levels because of the physician's specialty. CMS is also moving forward with the implementation of a new add-on code providing additional payment specifically for primary care and certain cognitive specialty E/M visits, originally intended to minimize the impact of payment cuts associated with previously proposed E/M code changes that CMS has since abandoned.

While AUGS members will benefit from the E/M code adjustments when they provide a new or established patient E/M visit not included in a global surgical package, Medicare Physician Fee Schedule budget neutrality requirements will result in a cut to Medicare's conversion factor that will mean payment reductions across all other services paid under the physician fee schedule and significant cuts to surgical services.   

A coalition of medical societies, including the surgical societies, is working with Congress to introduce legislation.  We are working on bill language that will implement a waiver of the budget neutrality rules for the new E/M code changes to protect the conversion factor for 2021.

Stay tuned for updates on this issue in future AUGS publications.  In the meantime, to read the letter to Speaker Pelosi and Leader McConnell sent by AUGS and other medical and surgical specialty societies, please click here.