Policy Statements

New 2021 Category III CPT Codes for Allogenic Disc Matrix Material On January 1, 2021, three new Current Procedural Terminology (CPT) codes for reporting the injection of allogenic disc matrix material went into effect. The three new CPT codes are: 0627T   Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar; first level   0628T   Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar; each additional level (List separately in addition to code for primary procedure)   0629T   Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with CT guidance, lumbar; each additional level (List […]

U.S. Congress Passes COVID-19 Relief Package Including Significant Provisions for Physician Practices On December 22, 2020, President Trump signed into law the Consolidated Appropriations Act, 2021, a comprehensive omnibus spending package that funds the federal government through fiscal year 2021, provides a new round of COVID-19 relief and economic stimulus, and imposes new restrictions on surprise medical billing. With respect to COVID-19 relief, the legislation would ease the impact of the Medicare fee schedule budget neutrality adjustments in calendar year 2021 due to improved evaluation and management office visit payment and coding rules, as well as an extension of the 2% Medicare sequester moratorium through March 2021. The surprise billing provisions include significant improvements over previous proposals, including a robust independent […]

ISASS Comments on the 2021 Final Outpatient Prospective Payment System/Ambulatory Surgical Center Rule On December 2, 2020, CMS finalized policy changes for the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rules. In this final rule, CMS indicated they will be 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 3-year transitional period, beginning with some 300 primarily musculoskeletal-related services. The IPO list will be completely phased out by the 2024 calendar year. This change 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 […]

CMS Provides Update to 2021 Final Physician Fee Schedule Rule On December 27, 2020, CMS finalized updated payment rates under its Medicare Physician Fee Schedule Rule for the 2021 calendar year (CY). These updates were made to reflect the Omnibus COVID-19 Relief Legislation passed by the U.S. Congress on December 27, 2020. Several items were included in the legislation that reduced the 11% conversion factor to around 4%. As a result, many procedures that would have otherwise had significant decreases in Medicare reimbursement will have either small decreases or small increases. The new physician fee schedule conversion factor for 2021 is $34.89. That is higher than the conversion factor finalized in the rule released in December, but it is 3.3% less than […]