Billing, Coding and 2021 Payment Schedules
AMA Summary of Congress' New COVID Relief Bill/Omnibus Budget - 12/21/20
E/M Changes and Physician Payment Adjustments
The legislation represents a significant win for physicians regarding Medicare physician payment. For Calendar Year 2021, the Medicare physician payment final rule indicated that there would be a 10.2% across-the-board reduction due to budget neutrality requirements. The new legislation dramatically reduces this budget neutrality adjustment in two ways:
- There will be an increase in the payment schedule of 3.75 percent. (This is applied across the board and without distinction to all payments under the Medicare physician payment schedule). This update is not subject to administrative or judicial review and shall not factor into future calculations of the fee schedule.
- Payments for HCPCS code G2211 are suspended for 3 years (through the end of December 2023). This code was finalized as an add-on code by CMS to account for visit complexity inherent to E/M visits. As calculated by the Medicare Physician Fee Schedule Final Rule, the G2211 code accounted for approximately $3 billion, or 3 percent of the reduction in the fee schedule. This delay in implementing the G2211 add-on code will further reduce the budget neutrality adjustment for 2021.
Taken together, these provisions related to Medicare physician payment mean the budget neutrality adjustment is significantly reduced. Based on the specialty impact table in the final rule, the AMA estimates that most specialties will now see either a neutral or positive change in total Medicare payments in 2021. Impacts for particular medical practices will depend on both physician specialty. Click here to read the CY2021 Combined Impact w/out G2211 in CF & Additional 3.75% increase in CF
Reminder – E/M Office Visit Code Changes Coming Jan. 1
Effective Jan. 1, 2021, the Centers for Medicare & Medicaid Services (CMS) is adopting updated Current Procedural Terminology (CPT®) Evaluation and Management (E/M) codes. The revisions only apply to office visits Code 99201 has been eliminated Codes 99202, 99203, 99204, 99205, 99206, 99207, 99208, 99209, 99210, 99211, 99212, 99213, 99214 and 99215 descriptors and documentation standards have been revised.
The AMA offers a wide variety of free tools and resources to keep you informed on critical updates such as the E/M office visit code changes. These resources include:
- Step-by-step videos on using medical decision-making (MDM) criteria or total time to select a code
- A table illustrating the MDM revisions
- A ten-step checklist to prepare your practice
- A detailed document with the E/M code and guideline changes (PDF)
- An interactive, educational module, “Office Evaluation and Management (E/M) CPT Code Revisions”
- FAQ: Are commercial health plans required to adopt revisions to the E/M codes?
Medicare COVID-19 Coding and Billing Info:
- Enrollment for Administering COVID-19 Vaccine Shots
- Coding for COVID-19 Vaccine Shots
- Medicare COVID-19 Vaccine Shot Payment
- Medicare Billing for COVID-19 Vaccine Shot Administration
- SNF: Enforcement Discretion Relating to Certain Pharmacy Billing
- Beneficiary Incentives for COVID-19 Vaccine Shots
- CMS Quality Reporting for COVID-19 Vaccine Shots
- *Updated* Medicare Monoclonal Antibody COVID-19 Infusion
- *New* COVID-19 Treatments Add-on Payment (NCTAP)
DVHA Provider Billing Info:
- COVID-19 Testing Billing and Coding Guidance - 10.09.2020
- Vermont Medicaid eliminated co-payments for hospital outpatient services and any other services related to COVID-19 testing, diagnosis, and treatment. Click for the latest fee schedule on the Vermont Medicaid Portal.
- Medicaid 2021 Resource-Based Relative Value Scale (RBRVS) fee schedule - to go into effect Jan. 1, 2021
- DVHA Information for Prescribers about Prior Authorization Extensions - 12.29.2020