CMS Updates 2021 Physician CF to $34.8931, a 3.3% Reduction from the 2020 CF - McDermott+Consulting

CMS Updates 2021 Physician CF to $34.8931, a 3.3% Reduction from the 2020 CF

The Centers for Medicare and Medicaid Services (CMS) announced a revised Medicare Physician Conversion Factor (CF) of $34.8931. The CF represents a 3.3% reduction from the 2020 CF of $36.0869. The 2021 Anesthesia CF is $21.5600, this is in comparison to the 2020 Anesthesia CF of $22.2016.

In the CY 2021 Medicare Physician Final Rule, CMS had originally finalized a 2021 CF of $32.4085. The 10% reduction from the 2020 CF was largely driven by payment increases to evaluation and management services as well as work relative value increases to other services.

CMS updated the CF as a result of a provision at the end of the year $1.4 trillion Consolidated Appropriations Act of 2021 (H.R 133) which was signed into law on December 27, 2020. The legislation directed Medicare to make a 3.75% positive adjustment to the CY 2021 physician payments, offsetting some of the 10.2% reduction. Second, the legislation placed a three-year moratorium (through CY 2023) on payment for the add-on code (G2211), further offsetting the cut.

In 2021, certain Medicare clinicians will also be subject to an additional +/- 7% payment adjustment based on their performance in the 2019 performance year of Merit-based Incentive Payment System of the Quality Payment Program.

Medicare contractors may need a few days to update their systems with the new conversion factor. Providers should contact their contractor for details on the timing of when claims will be processed under the new CF.

Click here to read our UPDATED: CMS Finalizes 10% Payment Cut, Expands Telehealth Services in 2021 Physician Fee Schedule +Insight.


For more information, contact Deborah Godes or Sheila Madhani.