NASS Insider


December 15, 2020


Changes to E/M Codes Go into Effect January 1, 2021


Over the last two years, the Centers for Medicare and Medicaid Services (CMS) have finalized changes to the Evaluation and Management (E/M) office visit code descriptors and documentation guidelines to reduce administrative burden to physicians. The new codes and guidelines will go into effect on January 1, 2021. The changes include:
  • Deletion of code 99201 and revised descriptors for codes 99202-99215
  • Selection of the appropriate code level will be based on medical decision-making or total time. History and physical exam will still need to be recorded, but will not be used for code level selection.
  • A new prolonged services code has been developed to be used to report 15 minutes of time once the procedure time exceeds that of the highest level codes (99205 and 99215).
Additional details and resources are available on the NASS website. The E/M changes also will be addressed in-depth during the upcoming January NASS Virtual Coding Course.

Final Rules for 2021 Medicare Payment for Physicians and Outpatient Departments/ASCs Released

CMS recently issued the final rules for 2021 Medicare payment for physicians and hospital outpatient departments/ASCs. Both rules will go into effect January 1, 2021. The most significant policy finalized is enactment of budget neutrality across the physician fee schedule, resulting in a 10.2% reduction in the conversion factor to account for significant payment increases for office-based E/M codes. This results in significant overall cuts to many procedural specialties. NASS and many other societies vigorously opposed this policy and continue to urge Congress to waive budget neutrality before the cuts go into effect. NASS members are urged to contact their members of Congress to support legislation halting budget neutrality for 2021 and 2022.

Other provisions of the physician rule include:
  • Nine CPT codes were permanently added to the list of codes covered under telehealth.
  • Numerous CPT were temporarily added to the list of codes covered as telehealth until the end of 2021 or the year in which the current COVID-19 public health emergency (PHE) ends.
  • A temporary code for audio-only telehealth visits was established.
  • MIPS Value Pathway (MVP) implementation has been delayed until 2022 or until the current PHE ends.
The key provisions in the hospital outpatient/ASC rule are:
  • The inpatient-only list of codes will be eliminated over a three-year period, with 298 codes (including numerous spine codes) removed beginning in 2021. This will allow these codes to be billed in outpatient and inpatient settings.
  • Beginning July 1, 2021, prior authorization will be required for cervical fusion with disc removal (CPT codes 22551, 22552) and implanted neurostimulators (CPT codes 63650, 63685, 63688) when performed in the outpatient setting.
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