April 1 Updates to MPFS Are no Joke
- By Renee Dustman
- In AAPC News
- March 6, 2020
- 4 Comments
April 1 is around the corner and you know what that means: quarterly updates. The Centers for Medicare & Medicaid Services (CMS) has released payer and provider guidance. Make sure all coding and billing staff are aware of the Medicare fee schedule changes.
Two New Physical Therapy Codes
MLN Matters® article MM1161 Revised, issued Feb. 27, summarizes the changes for the April update to the 2020 Medicare Physician Fee Schedule (MPFS).
Effective Jan. 1, 2020, there are two new HCPCS Level II codes with Status Indicator E Services not paid, non-allowed item or service:
G2168 Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes
G2169 Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes
Also effective Jan. 1, 2020, are relative value unit (RVU) changes for several HCPCS Level II codes. The list is available in MM1161, Table 2. Note that MM1161 was revised to change the malpractice (MP) RVU to 0.28.
See also MLN Matters MM11721.
CPT® Code Valuations
Effective for dates of service on and after Jan. 21, 2020, are indicator changes for a handful of CPT® codes added in 2020. See Table 3 in MM1161 for indicator changes for CPT® codes 20560, 20561, 97810, 97811, 97813, and 97814. The RVUs for these codes are listed, as well. These changes were necessary to coincide with a recent final decision memo for acupuncture for chronic low back pain.
Code Changes for Clinical Decision Support
Discontinued is HCPCS Level II code G1000 Clinical decision support mechanism applied pathways, as defined by the Medicare appropriate use criteria program, effective April 1, 2020.
Also effective April 1, 2020, are eight new HCPCS Level II codes (G1012-G1019). Table 5 in MM1161 indicates that these codes have a status indicator X Ancillary service, so there are no RVUs.
| G1012 | Clinical decision support mechanism AgileMD, as defined by the Medicare appropriate use criteria program |
| G1013 | Clinical decision support mechanism EvidenceCare imaging advisor, as defined by the Medicare appropriate use criteria program |
| G1014 | Clinical decision support mechanism InveniQA semantic answers in medicine, as defined by the Medicare appropriate use criteria program |
| G1015 | Clinical decision support mechanism Reliant medical group, as defined by the Medicare appropriate use criteria program |
| G1016 | Clinical decision support mechanism Speed of Care, as defined by the Medicare appropriate use criteria program |
| G1017 | Clinical decision support mechanism HealthHelp, as defined by the Medicare appropriate use criteria program |
| G1018 | Clinical decision support mechanism Infinx, as defined by the Medicare appropriate use criteria program |
| G1019 | Clinical decision support mechanism LogicNets, as defined by the Medicare appropriate use criteria program |
New Injection Codes
The April 2020 Alpha-Numeric HCPCS File lists a few other changes you should be aware of.
Added are HCPCS Level II codes:
| C9053 | Injection, crizanlizumab-tmca, 1 mg |
| C9056 | Injection, givosiran, 0.5 mg |
| C9057 | Injection, cetirizine hydrochloride, 1 mg |
| C9058 | Injection, pegfilgrastim-bmez, biosimilar, (ziextenzo) 0.5 mg |
Code Descriptor Changes Expand Services for NPPs
The long descriptors for HCPCS Level II codes G2061-G2063 are revised to add “and management service”:
| G2061 | Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes |
| G2062 | Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes |
| G2063 | Qualified nonphysician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes |
A similar change was recently made to the descriptors of CPT® codes 98970-98972, which are reserved for physicians and other qualified healthcare practitioners. HCPCS Level II codes G2061-G2063 are for non-physician practitioners (NPPs) to use to bill online “assessment and management” services for patients established to the practice.
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I read this above: See Table 3 in MM1161 for indicator changes for CPT® codes 20560, 20561, 97810, 97811, 97813, and 97814. Where is this to be found? I need to know about the changes in CPT Code values for 97813 and 97814.
Thank you
Please see the link to the MLN Matters article in the text.
what does it mean by Status Indicator = E services not paid?
Does this mean if you bill with the HCPCS G2168 it won’t get paid, because Medicare literally is not paying that code.
yes, that’s what it means. Generally, the claim would then be sent to the patient’s other insurance, if applicable.