On July 29th, CMS released the Proposed Rule for 2020. The Proposed Rule includes provisions on the physician fee schedule, MIPS program, and several regulatory programs impacting radiology.  Click here to view the complete Proposed Rule.

Brief highlights of the Proposed Rule are listed below. A more extensive review will follow in the upcoming months.

Fee Schedule

  • The Conversion Factor increased slightly from $36.04 to $36.09.
  • Even though the conversion factor increased slightly, diagnostic radiology and nuclear medicine are expected to decrease by 1% each and interventional radiology is expected to decrease by 2%.
  • Radiation oncology and radiation therapy fees are expected to remain unchanged.

Clinical Decision Support/Appropriate Use Criteria

  • CMS did not specifically address CDS/AUC in the Proposed Rule. However, on July 26th, CMS issued a separate transmittal outlining the modifiers and G codes that are to be used for this program.
  • A summary of these modifiers and G codes can be found here.

MIPS Program

CMS proposed several changes to the current MIPS program for 2020 and even through 2021 and 2022. Major changes and clarifications are listed below:

  • In 2020, the proposed weighting of the categories for quality, cost, promoting interoperability, and practice improvement activities is: 40%, 20%, 25%, and 15% respectively. An additional 5 percentage points shifts from quality to cost each year in 2021 and 2022 (proposed).
  • Despite changes to category weighting, most radiologists have been historically exempt from cost and promoting interoperability. Therefore, for radiologists, the composite score calculations will not change as significantly as other specialties.
  • For most radiologists, exemption from the promoting interoperability category is due to being either non-patient facing or hospital-based. As a reminder the definition of hospital-based is that a clinician provides 75% or more of their services in a hospital setting. In the 2020 Proposed Rule, CMS is proposing that a group can be considered hospital-based if 75% or more of the eligible clinicians are hospital based (previously this was 100% of eligible clinicians in a group).
  • The threshold to avoid a penalty in 2020 is proposed to be 45 points (2019 was 30 points). For 2021, the proposed threshold to avoid a penalty is 60 points.
  • To qualify as an ‘exceptional performer’, the proposed threshold in 2020 is 80 points. The proposed threshold in 2021 is 85 points.
  • The potential incentive/penalty for 2020 is proposed to be +9%/-9% of Medicare payments (up from +7%/-7% in 2019).
  • The data completeness threshold for 2020 is proposed to be 70%, up from 60% in 2019.
  • Small practices are still considered to be any practice with 15 or fewer providers. Small practices will still have the ability to report via the MIPS claims based reporting mechanism. Any practice with more than 15 providers must report via another mechanism (registry, alternative payment model, etc.).
  • The low volume threshold for MIPS exclusion is proposed to remain the same in 2020. A provider will continue to be exempt if that provider has less than $90,000 in Medicare allowed charges, sees less than 200 Medicare beneficiaries, or provides less than 200 Medicare services.
  • CMS is also proposing that any Targeted Reviews for MIPS scores must be requested within 60 days of the release of the Final MIPS scores.

MIPS Value Pathways (MVP’s)

  • In the proposed rule, CMS introduced the concept of MIPS Value Pathways (MVP’s), which would apply to MIPS in 2021 and beyond.
  • MVP’s would allow for more broad-brush reporting by specialty and would encompass all of the different categories in MIPS.
  • The four areas of focus for the future creation of MVP’s are:
  1. The MVP measures may be fewer in number and complexity, but would be more meaningful for each specialty.
  2. The MVP’s would provide comparative performance data to facilitate physician evaluation and encourage patient choice.
  3. The MVP’s would encourage reporting in high priority areas.
  4. The MVP’s would reduce barriers to Alternative Payment Models and could include APM measures to link cost and quality.
  • While CMS did provide a few examples of MVP templates in the Proposed Rule, the examples provided were more general and the information was mostly conceptual. So, at this point, the details of how this would pertain to radiology and the mechanics of reporting MVP’s are still not known. More information regarding MVP’s will be provided when it becomes available.

Payment for Evaluation and Management (E/M) Services

  • In the proposed rule, CMS is proposing to decrease the number of levels for office and outpatient new patient E/M visits to 4. The levels for established patients would remain at 5.
  • The proposed changes would also revise the coding based on time spent with the patient and medical decision making.  The performance of a history and exam would only be required when medically appropriate.

Physician Supervision Requirements for Physician Assistants

  • CMS is proposing to modify physician supervision requirements to provide Physician Assistants (PA’s) more flexibility in the services provided.
  • PA’s would be able to practice more broadly in accordance with state law and state scope of practice.
  • In the absence of state law, the physician supervision required by Medicare for PA services would be evidenced by documentation in the medical record of the PA’s approach to working with physicians in furnishing their services.

Direct Practice Expense Inputs for Ultrasound Room

  • Over the past year, CMS contracted with StrategyGen to review pricing of equipment and supplies, including ultrasound equipment.
  • StrategyGen has completed the review and the pricing for 70 equipment or supply items was updated, including increases to the pricing for ultrasound and vascular ultrasound rooms.

As always, ADVOCATE will continue to keep you up to date on all regulatory issues impacting radiology.


Wendy Driscoll, MBA

Senior Client Manager