Proposed medicare pps changes for 2021 and telehealth.

Proposed Medicare Physicians Fee Schedule Changes For 2021 And What It Means For The Future Of Telehealth

Centers for Medicare & Medicaid Services (CMS) released a proposed rule to update the Medicare Physician Fee Schedule (PFS) for the calendar year 2021. The 1,353 pages long proposal, according to CMS fact sheet, “is one of several … that reflect a broader administration-wide strategy to create a health care system that results in better accessibility, quality, affordability, empowerment, and innovation.” 

Lori Intravichit, CEO of Sunlit Cove Healthcare said:

In a nutshell, the new rule would increase payments for some physicians and decrease payments for others and change E/M coding guidelines. It offers limited expansion of telehealth services that Medicare covers.

PFS, Covid-19, And Telehealth

CMS Administrator Seema Verma said: “Telemedicine can never fully replace in-person care, but it can complement and enhance in-person care by furnishing one more powerful clinical tool to increase access and choices for America’s seniors.”

During the Covid-19 pandemic, CMS implemented 135 temporary waivers/codes related to Medicare. CMS is planning to keep nine of them, add 13 new ones and 74 codes will end when the pandemic is over.

Under the proposed rule, the permanent code will include the prolonged office or outpatient E/M visits, certain home visit services, and group psychotherapy. Nursing residents will see the frequency of telehealth visit limitations reduced from 30 days to every 3 days. Emergency department telehealth visits will end when the public health emergency is over. The audio-only visit coverage will be discontinued.

The proposed rule leaves many outstanding issues unanswered. Specifically, it does not address whether the geographic restrictions will remain lifted. Will Medicare continue to reimburse telehealth services at the same rate as in in-person services? And after the pandemic is over, will behavioral health providers, physical therapists, occupational therapists, and other therapy providers continue to be reimbursed for telehealth services?


In a U.S. Department of Health & Human Services survey of about 300 practitioners, they said only 9% percent of their patient interaction was via telehealth prior to the pandemic; but that increased to 51% during the pandemic period, and they expected it to remain at 21% after the pandemic ends.

Healthcare organizations need to think strategically about telehealth technology, patient needs, and goals during the telehealth service expansion. Sunlit Cove Healthcare Consultants can help you create a telehealth roadmap for your practice. Contact us or give us a call at (727) 278-3009 to get started. Contact us or give us a call at (727) 278-3009 to get started.

A blue and orange logo with a sun in the middle.

Sunlit Cove Healthcare Consultants

We provide management and consulting services to help healthcare businesses run efficiently. Navigating the dynamic and complex revenue cycle management is a challenge for many health plans, health care vendors, and providers. Our consulting services are available to assist with your day-to-day operations and provide expertise in growth and change management. We manage all aspects of your enterprise from the development of the revenue cycle management process to the completion of your business cycle.

Related: Telehealth

  • It only took a Covid-19 pandemic to prove that we can overcome the technology barriers of telehealth implementation. According to the Medical Economics® 2020 Telehealth-EHR survey:...

  • Your healthcare organization has successfully added a new telehealth system. Congratulations! Now what? How do you determine the success of the implementation? How do you scale kno...

  • Telemedicine plays a key to keeping healthcare workers, including physicians, and patients safe in the middle of the Covid-19 outbreak. According to McKinsey’s recent survey ...

  • In the pre-Covid-19 world, we often heard from physicians and decision-makers that telehealth implementation is difficult and time-consuming. Enter March 6, 2020, CMS telehealth wa...

  • 2020 saw many healthcare organizations scrambled to transition from traditional in-office to virtual care. Quick IT fixes, relaxed HIPAA regulations, expanded CPT codes, and Zoom v...