2021 Medicare Physician Fee Schedule

The healthcare world got an early holiday present from CMS on December 1st when Centers for Medicare & Medicaid Services (CMS) issued the final rule for Medicare payments and policy changes for the 2021 Physician Fee Schedule. See CMS Press Release.

Here are some highlights.  

• Many of the changes for 2021 include the permanent addition of around 60 new codes added during the COVID-19 Public Health Emergency (PHE).
• The following codes have been added to the Medicare Category 1 telehealth list:
  • Group Psychotherapy (CPT code 90853)
  • Psychological and Neuropsychological Testing (CPT code 96121)
  • Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT codes 99334-99335)
  • Home Visits, Established Patient (CPT codes 99347-99348)
  • Cognitive Assessment and Care Planning Services (CPT code 99483)
  • Visit Complexity Inherent to Certain Office/Outpatient Evaluation and Management (E/M) (HCPCS code G2211)
• Prolonged Services (HCPCS code G2212)
  • Other changes have been extended only through the end of the year during which the PHE ends. 
  • The following codes have been added to the Medicare Category 3 telehealth list, which will only be reimburse through the end of the calendar year that the PHE concludes: 
  • Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT codes 99336-99337);
  • Home Visits, Established Patient (CPT codes 99349-99350);
  • Emergency Department Visits, Levels 1-5 (CPT codes 99281-99285);
  • Nursing facilities discharge day management (CPT codes 99315-99316);
  • Psychological and Neuropsychological Testing (CPT codes 96130-96133; CPT codes 96136-96139);
  • Therapy Services, Physical and Occupational Therapy, All levels (CPT codes 97161-97168; CPT codes 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521-92524, 92507);
  • Hospital discharge day management (CPT codes 99238-99239);
  • Inpatient Neonatal and Pediatric Critical Care, Subsequent (CPT codes 99469, 99472, 99476);
  • Continuing Neonatal Intensive Care Services (CPT codes 99478-99480);
  • Critical Care Services (CPT codes 99291-99292);
  • End-Stage Renal Disease Monthly Capitation Payment codes (CPT codes 90952, 90953, 90956, 90959, 90962); and
  • Subsequent Observation and Observation Discharge Day Management (CPT codes 99217; CPT codes 99224-99226).
  • CMS will not continue audio-only codes after the PHE, but has added a new HCPCS G2252 on an interim basis for the duration of 2021, for an 11-20 minute discussion with a medical professional during which the need for an in-person visit could be determined.
  • Centers for Medicare & Medicaid Services (CMS) is committed to “keep exploring ways to deliver Americans access to healthcare in the setting that they and their doctor decide makes sense for them” according to HHS Secretary Alex Azar.

Here are some additional summaries and a fact sheet about the 2021 Physician Fee Schedule (PFS).

• A write-up, by Foley, breaks the final rule into the top five new telehealth polices for the 2021 PFS.
• Another write-up, by mHEALTH INTELLIGENCE, discusses the Category 1 and 3 codes above.
• CCHP created a Fact Sheet as well.