In August 2020, Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that announces upcoming changes for Medicare payments under the Physician Fee Schedule (PFS), beginning January 1, 2021. The 2021 proposed rule was intended to improve payments and decrease complexity for evaluation and management services, increase coverage for opioid use disorder treatments, and broaden telehealth service coverage. However, in order to compensate for the budgetary impact of these increases, which HHS is required to do, the rule implements a significant decrease in the value of other health care services. Unfortunately, payments to chiropractic physicians and other providers will be significantly reduced.
Medicare uses a system of “relative value units” (RVUs) to arrive at its fee schedule. Under this arrangement, each CPT code is given a value, expressed as a number of “RVUs,” that is then multiplied by a “conversion factor” to calculate the fee. (See detailed explanation below.) In short, Medicare is cutting the relative value units (RVUs) for 9894x codes by 10%. Additionally, they are cutting the conversion factor by over 10%. The result is a Medicare allowable amount cut of 19.54% for chiropractic adjustments. Of course, spinal adjustment – CPT codes 9894x – is the only service for which Medicare pays chiropractic physicians, and these changes are wholly unacceptable.
The FCA believes these changes and their impact to the chiropractic profession and our Medicare patients are unwarranted, ill-advised, and do not align with the rule’s purpose. As a result, we have taken and will be taking further action on your behalf.
WHAT WE HAVE DONE AND ARE DOING
The FCA filed official comments to CMS regarding the final rule earlier this week, and you can find a copy of our comment letter to CMS here. This is a critical step in our formal advocacy process to ensure that CMS is fully aware of the negative impact of these changes.
We are asking you to contact your Congressperson as soon as possible to prevent the rule from becoming finalized. With the assistance of the Congress of Chiropractic State Associations, we are able to provide you with the information and means to appropriately contact your Congressperson, asking them to act on your and your patients’ behalf. Many experts that believe that Congress will have to take action in order to stop these changes from occurring.
Additionally, in order to create a much larger impact, the FCA is taking proactive steps to work with the ChiroCongress and many other states to ensure that the chiropractic voice is heard widely by both CMS and by Congressional leaders.
BREAKDOWN OF THE PROPOSED CHANGES AND IMPACT
For a more detailed explanation of how the changes were calculated, the CMS proposed rule modifies two key factors that are important to chiropractic physician Medicare reimbursement: relative value unit (RVU) for the codes that are covered by Medicare and the conversion factor for all RVUs. Medicare uses the total RVU as a multiplier against the conversion factor to determine billable amounts for services. For example, CPT code 98940 (chiropractic manipulative treatment; spinal; 1-2 regions) has a national RVU of .8 in 2020, and the overall 2020 conversion factor is 36.09. The Medicare allowable amount is calculated by multiplying 36.09 x .8 = $28.87 as the national (not geographically adjusted) billable amount.
However, this proposed rule for 2021 will decrease the RVU for CPT code 98940 from .8 to .72 (a 10% decrease for all 9894x codes). To make matters worse, the rule will also lower the conversion factor from 36.09 to 32.2605 (a greater than 10% decrease). The overall effect of these two negative adjustments to the only covered codes for chiropractic physicians is a resulting 19.54% reduction in Medicare allowable amounts.
The FCA is, of course, strenuously opposed to these changes and has urged CMS to reverse the proposed decreases to the RVUs for CPT codes 9894x. In fact, the FCA urged CMS to increase the RVUs for spinal manipulation to reflect the E/M elements included in that service, to carry out the stated purpose of the rule and to provide parity with the proposed increases for E/M services that are covered when rendered by other providers.