The Centers for Medicare and Medicaid Services has proven that “final rules” are not always final. In response to complaints from physicians, CMS has delayed major changes to E/M codes until 2021.

While CMS moved ahead with parts of its plan to consolidate codes for Medicare patient visits, it made changes in response to the more than the 15,000 comments it received from physicians complaining that the plan would cut income for physicians who care for Medicare patients with complicated health conditions.

CMS Administrator Seema Verma said Nov. 2 that CMS will consolidate codes for E/M (evaluation and management) visits to three — keeping the level 5 code used for physicians who see those patients who require more services.

The agency will also delay implementation until 2021 so it can continue to work with doctors to iron out details.

             “We know this is going to have a tremendous impact on many physicians in America. We want to get it right,” Verma said.

Verma said doctors should not think that the two-year implementation means CMS will not enact the change. “I think this hasn’t been updated in 20 years,” she said about the coding requirements for physician services provided in office visits.

The E/M code changes are part of the final rule that outlines the physician fee schedule for 2019 along with changes to the third year of the physician payment system implemented under MACRA.

            The American Medical Association, the country’s largest physician organization, said it applauded the government for revising its original proposed E/M policies.

“The AMA also is grateful that the administration is not moving forward in 2019 with the payment collapse of E/M codes,” said AMA President Barbara L. McAneny, MD. The two-year window for implementation of the proposal will allow time for an AMA-convened workgroup to make recommendations on the complicated topic, she said.

CMS will finalize several burden-reduction proposals that doctors supported, effective Jan. 1, 2019. But in response to concerns, the final rule includes revisions that preserve access to care for complex patients, equalize certain payments for primary and specialty care and allow the delay in implementation of E/M coding reforms until 2021.

CMS backed off on immediate implementation after it received an avalanche of comments on the proposed rule released in July — many of them in opposition to the change, which would have collapsed payment rates for eight office visit services for new and established patients down to two each. Saying that it could underpay doctors who treat the sickest patients, more than 150 medical groups representing thousands of physicians sent a letter opposing the plan to consolidate E/M codes. VTN