The Centers for Medicare & Medicaid Services’ Overhaul of Office-Visit Payments—What’s the Bottom Line for Otolaryngology?

In November 2018, the Centers for Medicare & Medicaid Services (CMS) finalized historic changes to the Medicare Physician Fee Schedule in an effort to reduce administrative burden on health care professionals.¹ This reform will overhaul Medicare payment for Evaluation and Management (E&M) office visits beginning in January 2021. These visits account for approximately 20% of all Medicare charges under the Physician Fee Schedule and are of particular importance to otolaryngologists,¹ who provide a significant number of ambulatory services relative to other physicians.² In 2016, otolaryngologists conducted more than 5.1 million E&M office visits with Medicare patients.³ Otolaryngologists should understand several key aspects of the CMS rule, which has important implications for patient care.⁴