CMS Releases Proposed Rule for 2021 Physician Fee Schedule

On August 3, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes proposals to update payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2021. While the proposed rule predicts an almost 11% overall reduction in payments, the impact will not affect all physicians and specialties in the same manner. In fact, pain management specialists may realize a 7% increase overall in Medicare payments.

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CMS Issues Summary of Physician Fee Schedule Policies During the Public Health Emergency (PHE)

The Centers for Medicare and Medicaid Services (CMS) has issued a Medicare Learning Network (MLN) article with an effective date of June 12, 2020. The article summarizes the policy changes impacting the Physician Fee Schedule during the time of this Public Health Emergency (PHE). During the early part of the PHE, numerous changes were made to reimbursement policies associated with telehealth and non-face-to-face services. The article addresses the cumulative changes that occurred over this period. Specifically, the following topics are addressed:

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Administration Provides Financial Relief for Medicare Providers

The Centers for Medicare & Medicaid Services (CMS) is announcing an expansion of its accelerated and advance payment program for Medicare participating health care providers and suppliers, to ensure they have the res...
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Message from the AAPM President about COVID-19

‚ÄčAAPM has been monitoring CDC guidance related to COVID-19. Today AAPM President Ajay D. Wasan, MD MSc issued the following message to members. Dear Colleagues: By now I am sure that you have received many...
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CMS Approves First State Request for 1135 Medicaid Waiver in Florida

The state's approval letter can be found here , and includes flexibilities that enable the state to waive prior authorization requirements to remove barriers to needed services, streamline provider enrollment processes t...
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President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak

The Trump Administration today announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare fa...
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CMS Finalizes Decision to Cover Acupuncture for Chronic Low Back Pain for Medicare Beneficiaries

Before this final National Coverage Determination (NCD) reconsideration, acupuncture was nationally non-covered by Medicare. CMS conducted evidence reviews and examined the coverage policies of private payers to inform i...
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2020 Coding & CMS Policy Changes Webinar

AAPM coding and billing expert Emily Hill, PA will present a live webinar on December 11, 2-3 pm CT, designed to preview coding changes going into effect on January 1 related to pain medicine services. Learn more and reg...
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CMS Issues Final Rule for Physician Fee Schedule for 2020

The Centers for Medicare & Medicaid Services (CMS) issued its Final Rule for 2020 that that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS). As proposed, the 2020 PFS conversion factor is $36.09 which is $0.05 above the 2019 conversion factor. The conversion factor is multiplied by the total adjusted Relative Value Units (RVUs) to achieve a payment amount for the services included in the Medicare Physician Fee Schedule.

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Medicare Contractor Proposes Changes to Coverage Policy for Percutaneous Vertebral Augmentation (PVA)

  The Medicare Administrative Contractor, National Government Services, Inc.(NGS), released a future Local Coverage Determination for PVA Osteoporotic Vertebral Compression Fractures effective December 1, 2019. The ...
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Understanding the CMS Proposal for Opioid Treatment Services

AAPM members have asked about the impact on their practices of the CMS proposal for opioid treatment services. Starting January 1, 2020 the Centers for Medicare & Medicaid Services (CMS) plans to pay Opioid Treatment Programs (OTPs) for opioid use disorder (OUD) treatment services, including medication-assisted treatment (MAT) medications, toxicology testing, and counseling, when given to people with Medicare Part B.

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Opportunity for Input to CMS Action Plan on Pain Management and SUD ends October 11

CMS has issued a Request for Information (RFI) required by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) asking for public comment on way...
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Understanding CPT, RUC and the 2020 Proposed Rule

The Proposed Rule for the 2020 Physician Fee Schedule proposes values for intrathecal/epidural pump procedures (CPT codes 62367-62370), the new codes for injection and ablation of genicular nerves (temporary CPT 64XX0 and 64XX1) and sacroiliac joint (temporary CPT 6XX00 and 6XX01), and somatic nerve injections (CPT codes 64405, 64418, 64420, 64421, 64425, 64430, and 64450).

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CMS Proposes Payment for Acupuncture

CMS has announced a proposal to cover acupuncture for certain Medicare patients with chronic low back pain (CLBP). To be covered, patients must be enrolled participants either in clinical trials sponsored by the National...
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Medicare Launches Initiative for Documentation Look-Up Tool

Medicare recently announced a plan to streamline the process of finding coverage and documentation requirements for applicable services. Currently, documentation requirements appear in various locations and on separate websites requiring physicians and staff to navigate multiple websites for information.

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New Part D Opioid Overutilization Policies

CMS implemented new opioid policies for Medicare drug plans effective January 1, 2019. Medicare Part D enrollees who have not filled an opioid prescription recently (within the last 60 days) will be limited to up to a 7-...
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