Codapedia is now a division of Find-A-Code

Are you Ready for CMS' 2019 Medicare Physician Fee Schedule Final Rule?

November 7th, 2018 - Wyn Staheli, Director of Research
Categories:   Medicare   Reimbursement   CPT® Coding   Evaluation & Management (E/M)   MIPS|PQRS|PQRI  
0 Votes - Sign in to vote or comment.

The waiting is over, the Final Rule for CMS' 2019 Medicare Physician Fee Schedule (MPFS) is available - all 2,379 pages for those looking for a little light reading. As anticipated, there are some pretty significant changes. Most of us were carefully watching the proposed changes to the Evaluation and Management codes for office visits, but that's not all that was included in this 2,300+ page document. The following is a summary of some of the major provisions.

Evaluation & Management

CMS' stated goal was to reduce administrative burden when reporting these services. Some changes are happening right away and some will happen later. The following take effect January 2019:

Not all of the proposed changes relating to E/M services happened. The following office and outpatient visit changes were finalized, but they will not take place until 2021:

The following proposed changes were NOT finalized and thus will not be implemented:

Expand Technology & Telehealth Services

There are new codes to describe services rendered by healthcare providers using technology-based services. There are both telehealth codes as well as services that use technology services, but in and of themselves are not a telehealth service. Those services that are not telehealth but use technology to render the service are not subject to Medicare’s requirements for telehealth services (e.g., originating site, patient located in a rural or health professional shortage area).

CMS is also expanding coverage for communication technology-based services and remote evaluation services furnished by Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) when there is not another associated billable visit. This will be billed with the new code G0071.

Medicare will cover the following new codes:

G0071 — Virtual Communication

G2012 — Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional

G2010 — Remote evaluation of recorded video and/or images submitted by an established patient

99453, 99454, 99457 — Remote physiologic monitoring

99451, 99452 — Interprofessional Telephone/Internet/Electronic Health Record Consultations

See the Fact Sheet by the Center for Connected Health Policy, located in the References, for more about these services.

Telehealth Expansion

Medicare will also be adding the following to their approved telehealth coverage:

Substance Use Disorders Treatment

Assistants

Functional Reporting

Beginning in January 2019, functional reporting will no longer be required for reimbursement by Medicare. PTs, OTs, and SLPs will not be required to report HCPCS codes G8978-G8999 or G9158-G9186. Also, severity modifiers CH through CN will not be required. The codes are still going to be valid for a little while to allow providers and insurers time to update their billing systems and policies (and thus, avoid claim rejections due to inadvertent non-payable code submission).

If you want, you can continue to report the codes, they just aren’t required for payment. It should be noted that even though they aren’t required for payment, they may be used by MIPS-eligible PTs, OTs, and SLPs for MIPS quality reporting in 2019.

Low Volume Threshold & MIPS Participation

Low volume thresholds for MIPS participation were also revised. Beginning in 2019, if one of the following statements holds true for a MIPS-eligible clinician or group, they will not be required to participate in MIPS:

Even if you are not required to participate, you can choose to either opt-in to MIPS or voluntarily report. Clinicians and groups have the opportunity to opt in to MIPS if they only meet one or two of the three low-volume thresholds listed above. If you meet all three, then you may NOT opt in but you could still participate voluntarily and obtain feedback about your reporting. Those who voluntarily report quality data will experience no MIPS payment adjustments. Those who decide to opt in for 2019 will experience payment adjustments (positive, neutral or negative) in the 2021 payment year.

In order to opt in or voluntarily report, you MUST log into the Quality Payment Program portal and select the applicable option.

Other

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Check out our New Topic Pages!
January 17th, 2019 - Kristy Richie
We have created subject-specific landing pages with tools and resources for your convenience.  We understand how important your time is so we added another layer of organization to our site.  Check out our State pages for information on Workers Comp, Medicare, Medicaid and more... TOPIC pages are accessible at the top of every page on the ...
Take the Stress out of Leveling Using our E/M Calculator
January 17th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Our E/M Calculator takes the stress out of leveling Evaluation and Management codes. This tool can be used by auditors, as well as coders and students learning E/M coding. Calculate based on Time or Components. The exam portion lets you chose either 95, 97 Guidelines or both.  Included with our Professional and Facility Subscription!  ...
Scanning the Unscannable: Improving Patient Flow in MRI
January 14th, 2019 - BC Advantage
Stay Ahead of your CEUs in 2019Get the latest webinars and earn over 24 CEUs each year included with your BC Advantage Magazine subscription. Latest Webinar: Scanning the Unscannable: Improving Patient Flow in MRI Presenter: Wendy Stirnkorb, President & CEO Stirnkorb Consulting, LLC Time: 46 Minutes Cost: $0.00 to all BC Advantage Magazine Subscribers CEUs: 1.0 On-demand: Watch 24/7 from work or ...
What is Virtual Communication (G0071)?
January 14th, 2019 - NAMAS
Beginning January 1st, 2019 all of our RHC and FQHC organizations have a new CPT code to consider implementing for their Medicare populous (check per Advantage Plan Administration for coverage). In its current form, this code is not reportable by organizations not meeting the RHC/FQHC designation. The code isG0071 and is termed ...
AMA Issues new CMT Information
January 14th, 2019 - Wyn Staheli, Director of Research
As many of you may already be keenly aware, there have been ongoing problems with many payers (e.g., BCBS of Ohio) regarding the appropriateness of reporting an E/M visit on the same day as CMT (CLICK HERE to read article). The AMA recently released an FAQ which renders their opinion ...
Q/A: Is G8730 Still Required? Are G Codes Required at all?
January 14th, 2019 - Wyn Staheli, Director of Research
G8730, when is it required. Many G codes are still active and are required for non-quality reporting.
Nine New Codes for Fine Needle Aspirations (FNA)
January 4th, 2019 - Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
If your practice performs a lot of fine needle aspirations (FNA), you probably have the code options memorized (10021 without image guidance and 10022 with image guidance). However, the 2019 CPT codes now include nine (9) new FNA codes (10004-10012), one deleted FNA code (10022) and one revised FNA code ...



About Codapedia & Find-A-Code Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™/Find-A-Code™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2019 Find A Code, LLC - CPT® copyright American Medical Association