2021 Medicare Fee Schedule boost: See impact to pathology services

January 13, 2021

As part of the COVID relief and and appropriations package signed into effect Dec. 27, Congress took steps to mitigate significant fee schedule reductions for several specialties that were designed to offset payment boosts for evaluation and management (E/M) services.

Among the measures was a decision to offset previously announced cuts with an additional $3 billion from the Medicare Trust Fund, allowing each CPT code on the fee schedule to receive a 3.75% increase over previously announced 2021 MPFS rates. Additionally, payments for the complexity add-on G-code G2211 (Visit complexity inherent to certain office/outpatient E/M) were delayed for three years until 2024 and the 1.0 floor on the work Geographic Practice Cost Index was reinstated through CY 2023 to further reduce cuts.

As a result of these changes, the 2021 Conversion Factor increased to $34.89, a healthy jump from the CF of $32.41 that was initially announced with the 2021 MPFS Final Rule in December 2020.

Originally slated to see an overall payment reduction of 9% compared to the 2020 MPFS, pathologists will now only experience a 2%-3% reduction in 2021.

View the table below to see the impact of these changes on 2021 Medicare FFS rates for several major pathology services. Feel free to reach out to us directly if you’re seeking a national payment rate for a service not listed here.

CPT CodeInitial 2021Revised 2021Current 2020% Change 20-21
88112 – Global$63.52$67.69$68.57-1.3%
88112 – TC$37.92$39.77$39.700.2%
88112 – 26$25.60$27.91$28.87-3.3%
88120 – Global$604.12$632.90$589.347.4%
88120 – TC$550.00$574.64$529.078.6%
88120 – 26$54.12$58.27$60.27-3.3%
88121 – Global$434.94$456.71$450.401.4%
88121 – TC$390.22$408.21$399.512.2%
88121 – 26$44.73$48.50$50.89-4.7%
88184$67.41$69.78$68.212.3%
88185$22.36$23.03$22.382.9%
88187$34.03$36.63$39.34-6.9%
88188$58.99$62.80$66.04-4.9%
88189$78.76$85.13$88.78-4.1%
88305 – Global$66.76$71.52$71.460.1%
88305 – TC$32.09$33.84$32.125.4%
88305 – 26$34.68$37.68$39.34-4.2%
88307 – Global $272.89$290.28$281.503.1%
88307 – TC$196.40$206.90$194.886.2%
88307 – 26$76.49$83.39$86.62-3.7%
88309 – Global$414.52$441.70$427.663.3%
88309 – TC$279.37$294.82$275.007.2%
88309 – 26$135.15$146.89$152.66-3.8%
88312 – Global$106.63$113.04$107.195.5%
88312 – TC$82.00$86.18$79.408.5%
88312 – 26$24.63$26.87$27.79-3.3%
88313 – Global$77.46$81.64$77.235.7%
88313 – TC$66.12$69.43$64.607.5%
88313 – 26$11.34$12.21$12.63-3.3%
88341 – Global$88.80$93.85$94.19-0.4%
88341 – TC$62.55$65.24$64.601.0%
88341 – 26$26.25$28.61$29.59-3.3%
88342 – Global$99.82$106.07$107.19-1.0%
88342 – TC$67.41$70.82$70.370.6%
88342 – 26$32.41$35.24$36.81-4.3%
88367 – Global$109.87$115.83$115.130.6%
88367 – TC$78.43$81.99$79.403.3%
88367 – 26$31.44$33.84$35.73-5.3%
88368 – Global$129.64$137.12$133.892.4%
88368 – TC$91.40$95.60$90.585.5%
88368 – 26$38.24$41.44$43.31-4.3%
G0416 – Global$332.85$354.13$347.901.8%
G0416 – TC$167.24$175.50$162.408.1%
G0416 – 26$165.62$178.64$185.50-3.7%
G0452 – Global$46.02$49.54N/A 
G0452 – TC$2.92$3.14N/A 
G0452 – 26$43.11$46.40$19.12142.7%
Source: CMS

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