Coding Resource Center
September 2020
The Centers for Medicare and Medicaid (CMS) announced it has finalized the End Stage Renal Disease (ERSD) Treatment Choices (ETC) Model to improve or maintain the quality of care for beneficiaries with chronic kidney disease (CKD). This model will affect approximately 30 percent of kidney care providers with an estimated savings of $23 million over […]
The Centers for Medicare and Medicaid Services (CMS) proposed a new Medicare coverage pathway, the Medicare Coverage of Innovative Technology (MCIT), for FDA-designated breakthrough devices. This pathway would offer beneficiaries access to new and innovative devices and technologies to help improve their health outcomes, by providing national Medicare coverage on the same day as the […]
On September 8, 2020, the American Medical Association (AMA) published an update to the CPT® code set that includes two new codes for reporting medical services during the COVID-19 PHE. This update to the code set was approved by the CPT® Editorial Panel to “meet the needs of the health care industry as medical advancements […]
On September 1, 2020, the American Medical Association (AMA) released the 2021 Current Procedural Terminology (CPT®) code set after approval from the CPT® Editorial Panel. There are 329 editorial changes to CPT® including: 206 new codes 69 revised code descriptors 54 deleted codes The majority of new codes involve new technology services described in Category […]
August 2020
Last month it was announced that the Advance Beneficiary Notice of Noncoverage (ABN) form and instructions had been approved by the Office of Management and Budget (OMB) for renewal. The announcement originally instructed the mandatory start date for utilizing the renewed form would be August 31, 2020. However, due to COVID-19 concerns, CMS has expanded […]
The Office of Inspector General (OIG) has a dedicated COVID-19 webpage portal which provides extensive information and resources regarding all aspects of the COVID pandemic. Among other things, the portal contains policies and guidance, toolkits, the most up-to-date news, as well as quick links to additional resources from reputable sites such as the Centers for Disease Control […]
The Centers for Medicare and Medicaid Services (CMS) continues to field questions surrounding the use of telephone Evaluation & Management (E/M) CPT® codes 99441-99443 during the Public Health Emergency (PHE). CMS states these are patient-initiated services, but practitioners can provide education to beneficiaries on the availability of these services. For the duration of the PHE, […]
On August 10, 2020, The Centers for Medicare and Medicaid Services (CMS) announced the extension of the Educational and Operations Testing Period for the appropriate use criteria (AUC) and clinical decision support mechanism mandate through December 31, 2021. This decision is considered final and is not open to comment. The mandate is inclusive of all advanced diagnostic […]
July 2020
Alex M. Azar II, Secretary of Health and Human Services (HHS) announced the renewal of the public health emergency (PHE) declared due to the Coronavirus Disease 2019 (COVID-19). The PHE was originally declared on January 31, 2020 and renewed on April 21, 2020. The new extension went into effect on July 25, 2020 and will […]
On July 6, CMS issued a proposed rule (CMS-1732-P) that proposes to update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2021. This rule also proposes updates to the Acute Kidney Injury (AKI) dialysis payment rate for renal dialysis services […]
