January 26, 2021

CMS Announces Updated CPT codes and Instructions for E/M Office Codes for 2021

CMS Announces Updated CPT codes and Instructions for E/M Office Codes for 2021 The AMA CPT Editorial Panel has recently approved revisions to the Current Procedural Terminology (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. The most significant changes include: For an outpatient visit with an established patient, a provider can record only what has changed since the […]
January 26, 2021

CMS Releases 2021 Final Outpatient Prospective Payment System/Ambulatory Surgical Center Rule

CMS Releases 2021 Final Outpatient Prospective Payment System/Ambulatory Surgical Center Rule On December 2, CMS finalized policy changes for the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rules. In this final rule, CMS will begin eliminating the inpatient only (IPO) list of 1,700 procedures for which Medicare will only pay when performed in the hospital inpatient setting over a three-year transitional period, beginning with some 300 primarily musculoskeletal-related services. The IPO list will be completely phased out by calendar year (CY) 2024. This will make these procedures eligible to be paid by Medicare when furnished in the hospital outpatient setting when outpatient care is appropriate, as well as continuing to be payable when furnished in the […]
January 26, 2021

CMS Releases 2021 Final Physician Fee Schedule Rule

CMS Releases 2021 Final Physician Fee Schedule Rule On December 1, 2020, CMS finalized its Medicare Physician Fee Schedule Rule for the calendar year (CY) 2021. Office and Outpatient Evaluation and Management (E/M) Visits Last year, CMS finalized an important policy change in the 2020 Medicare Physician Fee Schedule Final Rule when it adopted CPT guidelines to report office and outpatient E/M visits based on either medical decision making or physician time and reduce unnecessary documentation. These changes were made effective January 1, 2021, to allow for extensive education on use of the new guidelines and revised codes. CMS also adopted the relative value recommendations made by the American Medical Association (AMA)/Specialty Society Relative Value Scale (RVS) Update Committee (RUC) […]
December 20, 2020

CMS Releases Proposed Rule on Durable Medical Equipment

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 […]