The 2021 Medicare Payment and CPT Coding Update

 

This year’s changes bode well for family physicians, with an expected increase in Medicare allowed charges.

Fam Pract Manag. 2021 Jan-Feb;28(1):oa1-oa4.

Author disclosure: no relevant financial affiliations disclosed.

Published online ahead of the January/February 2021 issue on Jan. 5, 2021.

Last year was one of the most challenging family medicine has ever experienced. But the start of 2021 ushered in changes to Medicare documentation and payment policy that should provide some financial help and some documentation relief. This article includes a summary of those reforms, as well as changes to CPT coding and Medicare’s Quality Payment Program (QPP) that are relevant to family physicians.

MEDICARE PHYSICIAN FEE SCHEDULE CHANGES

The most impactful change in the 2021 Medicare Physician Fee Schedule is the revaluation of the office/outpatient evaluation and management (E/M) codes, 99202-99215. Between that and other changes, the Centers for Medicare & Medicaid Services (CMS) initially estimated that family physicians would receive an increase of 13% in Medicare allowed charges, but following last minute Congressional action to address the budget neutrality requirement, the overall increase will likely be slightly lower. Official CMS projections are pending, and this article will be updated when they are available.

In addition to increasing E/M office visit values, CMS revalued multiple code sets related to E/M. They include codes for the following services:

  • Transitional care management services,

  • Maternity services,

  • Cognitive impairment assessment and care planning,

  • Initial preventive physical examinations (“Welcome to Medicare” visits) and annual wellness visits,

  • Emergency Department visits.

Remote patient monitoring. CMS is also making several changes that should make it easier to bill Medicare for remote patient monitoring (RPM) of physiologic parameters:

  • Permanently allowing consent to be obtained at the time RPM services are furnished,

  • Allowing auxiliary personnel to furnish RPM services (as described by CPT codes 99453 and 99454) under the billing physician’s supervision,

  • Clarifying that RPM services can be furnished to patients with acute conditions as well as those with chronic conditions,

  • Clarifying that interactive communication (for the purposes of CPT codes 99457 and 99458) involves real-time synchronous, two-way audio interaction that is capable of being enhanced with video or other data transmission.

When the COVID-19 public health emergency (PHE) ends, CMS will again require that an established patient-physician relationship exist before furnishing RPM services and that at least 16 days of data be collected and transmitted each 30 days to bill codes 99453 and 99454. But as long as the PHE persists, CMS will continue allowing RPM services for new patients and allowing reporting of codes 99453 and 99454 even when fewer than 16 days of data have been collected.

Virtual check-ins. In another move that should be helpful during the pandemic, CMS has created an interim virtual c

ABOUT THE AUTHOR

Dr. Church is a family physician practicing rural medicine in Hiawassee, Ga. He is core faculty for the Northeast Georgia Medical Center Family Medicine residency program and an American Academy of Family Physicians (AAFP) adviser to the American Medical Association's CPT Editorial Panel. Erin Solis is manager of practice and payment at the AAFP. Kent Moore is senior strategist for physician payment at the AAFP.

Author disclosure: no relevant financial affiliations disclosed.

 
 

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