Update to 2021 Medicare Physician Fee Schedule

January 12, 2021


Enacted on Dec. 28, the Consolidated Appropriations Act (CAA) (H.R. 133) provides a 3.75% increase in payments under the calendar year (CY) 2021 Medicare Physician Fee Schedule (MPFS).  The Centers for Medicare & Medicaid Services (CMS) recalculated CY 2021 MPFS payment rates and the conversion factor to reflect this increase.  The revised CY 2021 MPFS conversion factor is 34.8931, and updated payment information is available on the CMS CY 2021 MPFS final rule website under Downloads.

This payment increase is applicable to physician services furnished under the MPFS from Jan. 1 through Dec. 31, 2021.  It is not applicable to payments made for services furnished under a Medicare Advantage plan.  To pay for this increase, the CAA authorized the transfer of $3 billion to the Federal Supplementary Medical Insurance Trust Fund with additional funds available should the U.S. Department of Health and Human Services determine their necessity.

Additional provisions of the CAA affecting CY 2021 MPFS payments include:

  • Suspension of 2% sequester cuts through March 31, 2021;
  • Reinstatement of the 1.0 floor on the work Geographic Practice Cost Index through CY 2023; and
  • Delayed implementation of the inherent complexity add-on code for evaluation and management services (G2211) until CY 2024.
An IHA summary of the CAA is here, and an IHA fact sheet highlighting major provisions of the CY 2021 MPFS final rule is here.  Please send questions or comments to IHA.