Policy Statements

COVID-19 Vaccine Resources Released CMS and the American Medical Association (AMA) have both developed resources to support efforts to communicate about the COVID-19 vaccine. Please see links and information below if you are interested in providing information and updates to patients and staff. During the COVID-19 public health emergency, Medicare will cover and pay for the administration of the vaccine (when furnished consistent with the emergency use authorization). Physicians should review Medicare payment and Healthcare Common Procedure Coding System (HCPCS) Level I Common Procedural Terminology (CPT) code structure for specific COVID-19 vaccine information. They should only bill for the vaccine administration codes when submitting claims to Medicare; vaccine product codes should not be included when vaccines are free. CMS Information: CMS COVID-19 […]

CMS Extends MIPS Deadline to February 2021 To further support clinicians during the COVID-19 public health emergency, CMS is extending the 2020 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances Exception application deadline to February 1, 2021. For the 2020 performance year, CMS will be using the Extreme and Uncontrollable Circumstances policy to allow MIPS-eligible clinicians, groups, and virtual groups to submit an application requesting reweighting of one or more MIPS performance categories to 0% due to the current COVID-19 public health emergency. If you have any concerns about the effect of the COVID-19 public health emergency on your performance data, including cost measures, for the 2020 performance period, submit an application now and be sure to cite COVID-19 as the reason […]

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 […]

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 […]