For more information, email us at info@girsinc.com or call us at 901-834-9119.
On December 1, 2020, the Centers for Medicare & Medicaid Services (CMS) issued the Physician Fee Schedule (PFS), and other Medicare Part B issues, Final Rule. This Final Rule includes updates on policy changes for Medicare payments on or after January 1, 2021 to create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation.
Why is it Important for #Medtech to Review the PFS?
The PFS pays physicians’ services administered in physician offices, hospitals, ambulatory surgical centers, skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries’ homes. Payment under the PFS is also made to several types of suppliers for technical services, often in settings for which no institutional payment is made. It is important to track the payment to providers as it will influence the access to medical technologies furnished in these settings of care. Also, the changes to the telehealth services and codes are included in the Final Rule and need to be tracked especially during the pandemic. Several National Coverage Decisions (NCDs) also are being retired which leaves the coverage decision to the Medicare Administrative Contractors (MACs).
Main Highlights
- The final CY 2021 PFS conversion factor is $32.41, a decrease of $3.68 from the CY 2020 as a result of the budget neutrality adjustment.
- Services added to the Medicare telehealth list on a Category 1 basis are similar to services already on the telehealth list.
- CMS is finalizing the addition of the following list of services to the Medicare telehealth list on a Category 3 basis:
- Home Visits, Established Patient (CPT codes 99349-99350)
- Emergency Department Visits, Levels 1-5 (CPT codes
- 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)
- End-Stage Renal Disease Monthly Capitation Payment codes (CPT codes 90952, 90953, 90956, 90959, 90962)
- Subsequent Observation and Observation Discharge Day Management (CPT codes 99217; CPT codes 99224-99226)
- CM finalized a frequency limitation for subsequent nursing facility telehealth visits of one visit every 14 days.
- CMS reiterated in this final rule that telehealth rules do not apply when the beneficiary and the practitioner are in the same location even if audio/video technology assists in furnishing a service.
- In the CY 2021 PFS proposed rule, CMS proposed to allow nurse practitioners (NPs), clinical nurse specialists (CNSs), physician assistants (PAs), and certified nurse-midwives (CNMs) to supervise the performance of diagnostic tests within their scope of practice and state law. Certified registered nurse anesthetists (CRNAs) to this list.
CMS is not finalizing the proposal or the corresponding regulation text for some drugs approved under section 505(b)(2) of the Federal Food, Drug, and Cosmetic Act.
- CMS is finalizing the removal of six outdated or obsolete National Coverage Determinations (NCDs).
For more information, email us at info@girsinc.com or call us at 901-834-9119.
Sources: For more information: https://www.federalregister.gov/public-inspection/2020-26815/medicare-program-cy-2021-payment-policies-under-the-physician-fee-schedule-and-other-changes-to-part
About GIRS
For more than 17 years, GIRS has been assisting medical technology manufacturers with their market uptake and reimbursement strategies so that patients can have access to the care that they need. To implement successful market access strategies, the GIRS Value Discovery Landscape Assessments® team and the Payer Advocacy Compass® team work together to develop and implement foundation reimbursement landscape and payer advocacy strategies to obtain positive coverage, appropriate payment, and innovative payer contracting arrangements to improve market uptake.Disclaimer: The information in this blog is based on payer information which is dynamic. It is accurate at the time of posting but should not be construed to be reimbursement or legal advice. CPT® is the trademark of the American Medical Association (AMA)