Coding Resource Center
January 2021
On December 27, the Consolidated Appropriations Act, 2021, passed by Congress, has modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS). Changes include: 3.75% increase in MPFS payments for CY 2021; Suspension of the 2% payment adjustment (sequestration) through March 31, 2021; Reinstatement of the 1.0 floor on the work Geographic Practice Cost […]
On January 7, 2021, 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, July 25, 2020, and October 23, 2020. These […]
December 2020
The CMS 2021 HOPPS final rule begins the three-year phasing out of the Medicare Inpatient-Only (IPO) List, which designates procedures and services that can only be reimbursed in an inpatient hospital setting. Procedures removed from the IPO list will now be eligible for outpatient payment when outpatient care is deemed appropriate for the case. For […]
Novitas Solutions, Inc. – the proposed local coverage determination for endovenous stenting has been posted for notice and will become effective December 27, 2020. This LCD includes a local coverage article (A56414), which specifies codes for TIPS and DIPS: 37182 – Insertion of transvenous intrahepatic portosystemic shunt(s) (TIPS) (includes venous access, hepatic and portal vein […]
Section 3709 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended the payment adjustment percentage of 2 percent applied to all Medicare Fee-For-Service (FFS) claims from May 1 through December 31, 2020. This means providers would expect to receive a 2 percent increase in their FFS claims for this time period. In exchange […]
CMS issued an Interim Final Rule with Comment Period, which established the New COVID-19 Treatments Add-on Payment (NCTAP) under the Medicare Inpatient Prospective Payment System (IPPS), effective from November 2, 2020, until the end of the Public Health Emergency (PHE) for COVID-19. The Medicare program will provide an add-on payment for eligible inpatient cases that […]
The U.S. Preventive Services Task Force (USPSTF) guidelines are the most widely used criteria for screening for abdominal aortic aneurysms (AAA). The current USPSTF guidelines recommend a one-time abdominal ultrasound in men 65 to 70 years of age with a history of smoking. Criteria from the Society for Vascular Surgery (SVS) is also used, and […]
November 2020
The American Medical Association (AMA) published an update to the CPT® code set to include two new Category I vaccine-specific codes for the coronavirus immunizations: 91300 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use 91301 – Severe acute […]
On November 2, CMS issued a final rule that updates 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 provides updates to the Acute Kidney Injury (AKI) dialysis payment rate for renal dialysis services […]
October 2020
The Centers for Medicare and Medicaid (CMS) revised its fact sheet for ICD-10-CM, ICD-10-PCS, CPT and HCPCS Code Sets. This information is published by the Medicare Learning Network® and provides the definition, details and general payment information for each code set used to bill Medicare claims. This is a good reference for providers, suppliers, coders […]
