Final 2020 MPFS maintains neutral adjustment for pathology, signals significant 2021 cuts

November 5, 2019

While CMS largely stuck by proposed Medicare Physician Fee Schedule rates for pathology and independent lab services in its 2020 MPFS Final Rule released Nov. 1, those services may not be so fortunate in 2021 when planned increases for evaluation and management services are expected to be offset by cut rates for pathology and other specialties that don’t generally bill office and outpatient E/M.

An analysis of expected allowed charges across specialties reveals CMS intends to keep overall payment adjustments for pathology and independent lab services mostly neutral, with those specialties set to receive 0% and 1% adjustments, respectively. However, CMS reaffirmed that in 2021 pathology will see a roughly 8% overall decrease in payment due to long signaled revisions to coding and payment for E/M services. Independent lab services would also decrease by an estimated 4% when these changes take effect.

The most significant cuts in 2020 will again impact payments for additional flow cytometry markers and the technical component of prostate biopsies, two areas CMS has continued to target for significant reductions in recent fee schedule updates.

The final conversion factor for 2020 is $36.09, a slight bump over the finalized 2019 rate of $36.04. The increase represents a 0.14% increase from the 2019 conversation factor.

CPT CodeFinal 2020Current 2019% Change
88112 – Global$68.57 $68.47 0.1%
88112 – TC$39.70 $39.28 1.1%
88112 – 26$28.87 $29.19 -1.1%
88120 – Global$589.34 $608.70 -3.2%
88120 – TC$529.07 $548.52 -3.5%
88120 – 26$60.27 $60.19 0.1%
88121 – Global$450.40 $488.33 -7.8%
88121 – TC$399.51 $437.15 -8.6%
88121 – 26$50.89 $51.18 -0.6%
88184 – TC$68.21 $67.75 0.7%
88185 – TC$22.38 $24.87 -10.0%
88187 – TC$39.34 $38.92 1.1%
88188 – TC$66.04 $65.95 0.1%
88189 – 26$88.78 $88.30 0.5%
88305- Global$71.46 $70.28 1.7%
88305 – TC$32.12 $30.63 4.9%
88305 – 26$39.34 $39.64 -0.8%
88307 – Global $281.50 $273.54 2.9%
88307 – TC$194.88 $186.68 4.4%
88307 – 26$86.62 $86.85 -0.3%
88309 – Global$427.66 $415.53 2.9%
88309 – TC$275.00 $262.00 5.0%
88309 – 26$152.66 $153.53 -0.6%
88312 – Global$107.19 $101.99 5.1%
88312 – TC$79.40 $74.24 7.0%
88312 – 26$27.79 $27.75 0.1%
88313 – Global$77.23 $73.88 4.5%
88313 – TC$64.60 $61.27 5.4%
88313 – 26$12.63 $12.61 0.2%
88341 – Global$94.19 $94.42 -0.2%
88341 – TC$64.60 $64.51 0.1%
88341 – 26$29.59 $29.91 -1.1%
88367 – Global$115.13 $111.00 3.7%
88367 – TC$79.40 $74.96 5.9%
88367 – 26$35.73 $36.04 -0.9%
88368 – Global$133.89 $129.38 3.5%
88368 – TC$90.58 $85.77 5.6%
88368 – 26$43.31 $43.61 -0.7%
G0416 – Global$347.90 $386.34 -9.9%
G0416 – TC$162.40 $200.74 -19.1%
G0416 – 26$185.50 $185.60 -0.1%

Have questions about a particular code you don’t see listed here? Reach out to us directly at 517-486-4262 for more information.

*All national rates calculated using the 2020 conversion factor of $36.09.

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