CWCI Research compares 2018 and 2019 data on Evaluation and Management Services before and after the switch from a statewide to an MSA-based geographic adjustment factor within the OMFS. The study looks for changes in the distribution of E&M services and payments among MSA-assigned counties; the average amounts paid within MSA-assigned counties; the overall mix of E&M services used within the state; and the proportion of E&M services that were paid below the amount allowed by the fee schedule and the change in the average discount. The report includes background information, detailed graphics and analyses, a summary discussion, and appendices. $12.