Medicare Impact of 2021 E&M Guideline changes

CMS has made significant changes in 2021 to both their conversion factor and the RVUs for E&M services.
We have analyzed these changes. Selecting codes may become more arduous with the new E&M add-on codes. CMS believes that the overall finanical impact will be very modest, but we find that most practices will have some financial and RVU impact.
To see how the new RVUs and conversion factor will impact your providers, either:
  • Enter the number of times you expect to perform each service, or
  • Enter their NPI code in the field below, which will give you a head start by looking up the latest data available to us (2018).
The calculations use the difference between the 2020 and 2021 RVU values with your office visit procedure counts.
  • For the new G2212 code, CMS expects that this will be used for 5% of your 99205 and 10% of your 99215.
    The form will populate counts based on these assumptions when you enter values for 99205 and 99215 (which you may overwrite).

Year:    NPI to research: 

Interpretation Guide

For each procedure code, there are five columns:
  1. Total RVU Delta – This is the difference between the 2021 and 2020 non-facility total RVU times the Total Count.
  2. Financial Delta – This column involves several calculations. First, we multiply the count times the total RVU for both 2020 and 2021. Then, we multiply the respective total RVU values times the respective conversion factors. The next step is to subtract the 2020 allowed from the 2021 allowed. This gives us the best estimate for the financial difference.
  3. Financial Impact – Here, we divide the financial delta by the 2020 allowed amount based on the counts you report in the Total Count field. The purpose here is to calculate what the percent change will be moving from 2020 to the 2021 model.
  4. Work RVU Delta – This is simply the difference between the 2020 and 2021 work RVUs times the Total Count. Note that work RVUs did not change for existing codes.
  5. Work RVU Impact – For this column, we take the Work RVU Delta and divide it by the total work RVU for 2020 (based on the values in the Total Count column).