9.6% in 2020 Anesthesia Reimbursement from Medicare

With the publication of the 2021 PFS Final Rule on December 1, the nation’s anesthesiologists and anesthetists were left in dismay, if not disbelief, having been dealt a significant financial setback.  The national anesthesia CF for 2021 has been set at 20.0547, down from the 2020 CF of 22.2016.  This represents a 9.6 percent decrease in potential anesthesia revenue—from a conversion factor perspective.  The exact anesthesia CF will vary based on your practice location.  To determine the anesthesia CF in your area, you can visit the following link: https://www.cms.gov/Center/Provider-Type/Anesthesiologists-Center.

This is the second year in a row that Medicare has reduced the reimbursement to the Anesthesia specialty. 

Anesthesia Conversion Factor (CF) rose 0.27 percent to $22.27 from $22.19 in 2018

The Centers for Medicare and Medicaid Services (CMS) has published the 2019 Physician Fee Schedule (PFS) final rule detailing, among other things, how anesthesia practitioners will be paid in the coming year and how their participation in Year 3 of the Quality Payment Program (QPP) could impact their payment in 2021.

The national anesthesia conversion factor (CF) rose 0.27 percent to $22.27 from $22.19 in 2018, reflecting anesthesia-specific resource costs related to practice expenses and malpractice insurance. This CF represents the national average. The table here shows the 2018 and 2019 anesthesia CFs by location.*

The non-anesthesia CF also rose slightly from $35.99 to $36.04, representing a 0.25 percent adjustment as mandated by the Bipartisan Budget Act of 2018 as well as a negative 0.14 percent adjustment in keeping with the law’s budget neutrality requirements. Anesthesiologists would use this CF to bill for flat fee services, such as the use of ultrasound guidance and nerve block placement.

As proposed, the work relative value unit (RVU) (one of the three components used to determine fees) for CPT code 95970 (Electronic analysis of implanted neurostimulator pulse generator/transmitter) was reduced from 0.45 to 0.35 for 2019.

Some changes in documentation requirements for E&M services designed to ease administrative burden for clinicians will be implemented in 2019. We are analyzing these changes and will discuss them in a future eAlert. We will also discuss the implications for anesthesia and pain management providers of the significant expansion of payment for telehealth services that became policy with the final rule.