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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:

  • Expansion of telehealth services to include certain hospital-based services
  • Outlines the change in requirements for telehealth modalities
  • Expansion of virtual check-in services to new and established patients
  • Direct supervision requirements for services provided by clinical staff
  • Reimbursement of telephone services and expansion of codes to both new and established patients
  • Documentation, code selection and reimbursement of E/M services during the PHE
  • Changes to supervision requirements for diagnostic tests
  • Application of Teaching Physician requirements for residents and expansion of therapy services provided by students
  • Flexibilities for Opioid Treatment Programs to use interactive technology for counseling, therapy and assessments
  • Guidelines for ordering COVID-19 testing

​ The article can be accessed here.

Get Ready for 2020: AAPM’s Coding Webinar on Wednesday, December 11 at 2 pm CT

Don’t miss out on valuable coding and reimbursement information needed for success in 2020. AAPM is hosting a webinar on Wednesday, December 11 at 2PM CT that will discuss new and revised CPT codes effective January 1, 2020, and Medicare initiatives important to your practice.  

The webinar will discuss the 2020 changes to the somatic nerve injection codes and the new injection and destruction codes for genicular and sacroiliac nerves. The webinar will also provide a look ahead to the changes in outpatient Evaluation and Management codes and the new approach to the CMS Merit-based Incentive Payment System (MIPS) both beginning in 2021.

There’s still time to register for the webinar and if you are unable to attend live, you can benefit from registering. All webinar registrants will receive access to a full recording in the AAPM Education Center following the course. Learn more and to register.

Medicare Beneficiary Identifiers (MBI) Required January 1, 2020

Starting January 1, 2020, you MUST submit claims using MBIs regardless of the date the service was performed. Claims submitted without the MBI will be rejected and not processed by Medicare. MBIs replace the Social Security Number (SSN)-based Health Insurance Claim Numbers (HICNs). MBIs are 11-characters in length and are made up only of numbers and uppercase letters (no special characters).

All existing Medicare beneficiaries have received new cards with their MBI and all new beneficiaries are issued MBIs. The patient’s MBI also appears on every electronic remittance advice for claims submitted with a valid and active HICN during the transition period. You can also look up any Medicare patient’s MBI, regardless of where the patient lives using your Medicare Administrative Carrier’s (MAC) portal. You can use this tool even after the end of the transition period on December 31, 2019.

If you have not begun the process of transitioning to the new MBIs, now is the time to start. Given that ALL Medicare claims must report the MBI on January 1, 2020, you can save a lot of time and avoid reimbursement delays by making the changes now.

CMS has web resources specific to the MBI that includes general information, resources for providers and managers and outreach and education tools and information. It can be accessed here

Many MACs have also provided outreach and educational information and tools. You can find your MACs website here.

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 new coverage policy poses increased clinical inclusion and exclusion criteria required for billing and conflicts with language proposed by a Multisociety Pain Workgroup working with CMS on coverage policies. 

NGS is the Administrative Contractor for 10 states (listed in the future coverage policy) and therefore a change in policy impacts many Pain Medicine physicians. AAPM is drafting a response to the policy and encourages interested members to comment as individuals as well. The Coverage Policy can be accessed directly here. Scroll down the page to see the full policy and references. Please watch for updates in future editions of the AAPM E-News.

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