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In review: Remote physiologic monitoring codes, descriptors and staff requirements
12/21/2020
by: Julia Kyles, CPC
CMS provided more guidance for coding and billing remote physiologic monitoring (see story, p. 1). The chart above provides codes, descriptors and the staff who may perform each service. Note that the services must be ordered and billed by a provider who can bill for E/M services.
2021 outlook: CMS takes aim at misvalued codes, retires group of NCDs
12/21/2020
by: Laura Evans, CPC
CMS finalized its proposal to consider revaluing one code over the next year: 22867 (Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance, when performed, with open decompression, lumbar; single level), which was nominated as undervalued in order to add the work of decompression.
More 2021 PFS updates: Care management code changes, COVID billing rules and more
12/21/2020
by: DecisionHealth Staff
From the adoption of a CPT code for chronic care management (CCM) services to a range of other billing and quality reporting updates, below you’ll find additional updates from the final 2021 Medicare physician fee schedule, which takes effect Jan. 1.
CMS selected-procedure chart highlights the 2021 CF blow to reimbursement
12/21/2020
by: Roy Edroso
Among the documents related to the final 2021 Medicare physician fee schedule that should interest practices is the “Impact on CY 2021 payment for selected procedures” chart, showing the estimated impact of reimbursement changes on procedures chosen by CMS “from among the procedures most commonly furnished by a broad spectrum of specialties.”
10% conversion factor cut offsets E/M gains, with wild fluctuations on the horizon
12/14/2020
by: Richard Scott
You’ll find a steep cut to the Medicare Part B conversion factor (CF) in 2021, in one part of a systemwide redistribution of the more than $100 billion in annual Part B provider payments. The CF falls 10.2% to a rate of $32.41 in 2021, down from $36.10 in 2020.
Simplify the visit complexity code: Forget specialty, focus on continuity
12/14/2020
by: Julia Kyles
You can earn an additional $16 for E/M office visits next year when the treating physician or other qualified health care professional acts as a “focal point of care.”
With HCPCS debut, take note of new rules for prolonged services
12/14/2020
by: Julia Kyles
You will count time in two ways if you report a prolonged service with an E/M office visit that is coded based on time next year. CMS calls CPT code 99417 — the add-on code for prolonged services — unclear and believes it can result in double-counting of time because the descriptor does not push far enough past the minimum time for the related office visit (99205 or 99215).
Telehealth expands even more, but will mostly go away unless Congress acts
12/14/2020
by: Roy Edroso
In the final rule, CMS cleared dozens of telehealth and telehealth-adjacent codes that nearly all providers can use right now. However, many of them are slated to be removed from general use after the COVID-19 public health emergency (PHE). A few codes, though, are exempt from the traditional telehealth rules.
APP debut, benchmark stasis, small changes mark QPP in PFS
12/14/2020
by: Roy Edroso
Aside from the delay of the MIPS Value Pathways (MVP) and the advance of the APM Performance Pathway (APP), the adjustments to the Quality Payment Program (QPP) and the Merit-Based Incentive Payment System (MIPS) do not veer too far from previous versions of the program. Yet experts warn that even minor changes can have a big impact on your performance.
Shared Savings gets routed into APP, but keeps Web Interface for one more year
12/14/2020
by: Roy Edroso
The Quality Payment Program (QPP) portion of the final 2021 Medicare physician fee schedule undergoes one major change — a new quality reporting method with both upsides and downsides — but participating accountable care organizations (ACO) get to hang onto the Web Interface option for one more year.
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