CDPHP Fee Schedule Changes-Effective 7/1/2021

May 4, 2021

Recently, based on the recommendation of the physician compensation committee, the CDPHP board of directors approved the 2021 fee schedule for all lines of business, including CDPHP Universal Benefits Inc. and CDPHP.

Accordingly, the following fee schedule changes will take effect on July 1, 2021:

Commercial Products

The CDPHP fee schedule is based on the Centers for Medicare and Medicaid Services (CMS) conversion factors and relative value units (RVUs). This year, the board of directors approved a 2% overall increase to the physician fee schedule using the 2021 CMS RVUs.

Medicare Products

In 2021, CDPHP approved an update to the Medicare fee schedules to convert to 2021 CMS RVUs for all providers who participate in the Medicare line of business.

State-Funded Program Fee Schedule (Medicaid, Essential Plan, and Child Health Plus)

In anticipation of the CMS rule changes related to the collapse of E&M codes, CDPHP has updated the hybrid fee schedule to equate all services to a percentage of CMS Medicare. For those who participate in CDPHP state-funded programs, the methodology for fee development remains as shown below in anticipation of the change to the CMS RVU-based codes in future years.

  • Clinical Lab – 70% of Commercial
  • Immunization Administration – 100%
  • Delivery Codes (59XXX CPT series) – 89% of Medicare
  • Office-based E&M – 61%
  • Facility-based E&M – 39%
  • Codes Unique to NYS Medicaid – 100% of NYS Medicaid
  • All Other Codes – 68% of Medicare

 

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