News

CMS Releases Proposed Rule on Durable Medical Equipment At the end of October, CMS proposed new changes to Medicare Durable Medical Equipment, Prosthetics, Orthotic Devices, and Supplies (DMEPOS) coverage and payment policies. This rule would provide more choices for beneficiaries with diabetes while streamlining the process for innovators in getting their technologies approved for coverage, payment, and coding by Medicare. The proposed rule would expand the interpretation regarding when external infusion pumps are appropriate for use in the home and can be covered as durable medical equipment under Medicare Part B, increasing access to drug infusion therapy services in the home. The proposed rule also drastically reduces administrative burdens—such as complicated government coverage, payment, and coding processes—that block innovators from […]

Members of Congress Urge CMS Administrator to Not Apply Prior Authorization Requirements for Cervical Fusion On November 2, over 50 members of Congress sent a letter to CMS Administrator Seema Verma urging her to not extend prior authorization requirements for cervical fusion procedures performed in the outpatient and ambulatory surgical center settings. CMS had previously announced in the Outpatient Prospective Payment System/Ambulatory Surgical Center proposed rule an intention to apply prior authorization to cervical fusion procedures, as well as spinal neurostimulator system procedures. In their letter, the members of Congress indicated disagreement with the CMS proposal and indicated that implementation of prior authorization would lead to delays in treatment for Medicare beneficiaries, which would negatively impact quality of life. The […]

AMA Announces Updated CPT codes and Instructions for E/M Office Codes for 2021 The American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel recently approved revisions to the CPT Evaluation and Management (E/M) office or other outpatient services codes, which will have significant implications on coding and documentation for these vital services. The changes are scheduled to go into effect January 1, 2021. In addition, CMS has approved updated Relative Value Unit settings for the E/M code set. The CPT changes are designed to reduce administrative burden and more accurately capture physician work involved in providing the services. Previously established changes include: For an outpatient visit with an established patient, a provider can record only what has changed since […]

CMS Releases Updated Rules on COVID-19 Vaccine and Therapeutics Proposed Rule On October 28, CMS finalized a fourth COVID-19 Interim Final Rule with Comment, which provides coverage and payment details for COVID-19 vaccines and therapeutics. Medicare will cover the cost of COVID-19 vaccines and their administration and will waive out-of-pocket costs for both traditional fee-for-service beneficiaries and beneficiaries enrolled in Medicare Advantage plans. Medicare will pay physicians $28.39 to administer coronavirus vaccines. For vaccines that require two doses, Medicare will pay $16.95 for the first dose and $28.39 for the second dose. These rates will be geographically adjusted. The rule also requires Medicaid, Children’s Health Insurance Program agencies, and most private health plans to administer the vaccine at no cost to patients […]