April 1 Updates to MPFS Are no Joke

April 1 Updates to MPFS Are no Joke

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.

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.

Renee Dustman
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Renee Dustman

Executive Editor at AAPC
Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.
Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

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