iRhythm: Publication of Final Physician Fee Schedule Likely on December 1 or 2 Despite Existing Delay

The Center for Medicare and Medicaid Services (CMS) will likely not publish the final Physician Fee Schedule until December 1 or 2, according to a source familiar with CMS processes. The agency is currently reviewing its proposed Physician Fee Schedule for 2021, which sets reimbursement rates for a wide variety of medical services and equipment, after receiving public comment and feedback from industry groups.

CMS’ current proposal includes a new reimbursement code for electrocardiographic (ECG) monitoring, which would reimburse the service at a rate of $375.83 and $386.16 for 1 or 2 weeks’ worth of recording, respectively. The proposed rates could provide a windfall to iRhythm Technologies (IRTC), which dominates the ECG monitoring industry, though public comments on the CMS proposal have advocated for a much lower reimbursement rate in the final rule.

CMS was statutorily required to publish the final Physician Fee Schedule 60 days before its effective date January 1, 2021, in order to give Medicare Administrative Contractors and other insurers time to update their respective billing systems. However, under the declared coronavirus Public Health Emergency, “we are hereby waiving the 60-day delay in the effective date of the final rule, and replacing it with a 30-day delay in the effective date of the final rule,” CMS wrote in its proposed rule.

Despite the looming January 1 implementation date, there are still some regulatory hurdles to be cleared before publication of any final rule. The Office of Management and Budget’s Office of Information and Regulatory Affairs is currently reviewing CMS’ final rule, and has meetings with industry groups set for this afternoon and November 17.

According to a source familiar with CMS processes, while CMS wouldn’t publish the final rule before receiving OMB clearance, it’s unlikely that CMS would publish soon after OMB wraps up these meeting.

“I would expect it will come out either December 1 or 2,” the source said, adding that “I am highly doubtful it will come out any earlier just because these rules tend to always come out on the last possible day.”

In response to a request for comment, a CMS spokesperson told The Capitol Forum that “this rule is currently in the rulemaking process and we do not comment on rules that are in the rulemaking process.”