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Physician Fee Schedule CY2021

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This final rule updates policies affecting the calculation of payment rates and includes misvalued codes. It also adds services to the telehealth list including a third temporary category for services added under the PHE, as well as certain other revisions to telehealth services. It also addresses direct supervision as it relates to interactive technology, payment […]

AMA Announces new COVID-19 vaccine CPT® codes

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The American Medical Association (AMA) announced that the Current Procedural Terminology (CPT®) code set is being updated by the CPT Editorial Panel to include immunization and administration codes that are unique to the COVID-19 vaccine under development by AstraZeneca and University of Oxford. The new CPT codes will be effective for use on the condition […]

CY2021 Physician Fee Schedule Proposed Rule

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CMS issued a proposed rule on August 3, 2020, on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2021. This document is scheduled for publication in the Federal Register on August 17, 2020 Background on the Physician Fee Schedule Since […]

OPPS Proposed Rule CY2021

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On August 4, 2020, the CMS proposed policies that aim to increase choice, lower patients’ out-of-pocket costs, empower patients, and protect taxpayer dollars. These proposed changes would build on existing efforts to increase patient choice by making Medicare payment available for more services in different sites of service and adopting policy changes under the Medicare […]

CY2021 ESRD Proposed Rule

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On July 6, CMS issued a proposed rule that proposes to update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2021. This rule also proposes updates to the Acute Kidney Injury (AKI) dialysis payment rate for renal […]

Point of Origin Code Indicating Transfer from a Designated Disaster Alternative Care Site

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MLN Number MM11836 Revised was released July 1, 2020 that changes the implementation date to August 3, 2020. View the MLN: https://www.cms.gov/files/document/MM11836.pdf Official instruction, CR11836, issued to MACs: https://www.cms.gov/files/document/r10205OTN.pdf

Proposed Expanded Coverage for TEER for Patients with Mitral Valve Regurgitation

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On June 30, CMS proposed to update its national coverage policy for a procedure known as transcatheter edge-to-edge repair (TEER) of the mitral valve to include patients with functional mitral regurgitation (MR).  TEER is a less invasive treatment option that involves clipping together a portion of the mitral valve leaflets for patients with a condition […]

IPPS and LTCH Proposed Rule FY2021

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On May 11, 2020, the Centers for Medicare & Medicaid Services (CMS) proposed a rule that focuses the agency’s efforts on a singular objective: transforming the healthcare delivery system through competition and innovation to provide patients with better value and results. The proposed rule would update Medicare payment policies for hospitals under the Inpatient Prospective […]

ReOpening America Guidelines – Phase 1 – April 19, 2020

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From the Centers for Medicare and Medicaid Services: The United States is experiencing an unprecedented public health emergency from the COVID-19 pandemic. Healthcare facilities in some areas are stretched to their limits of capacity, and surge areas have been needed to augment care for patients with COVID-19. To expand capacity to care for these patients […]