8/17/2023 0 Comments Reiterating to clarify meaningCategory 3 describes services added to the Medicare telehealth list during the public health emergency (PHE) for the COVID-19 pandemic (COVID-19 PHE) that will remain on the list through the calendar year in which the PHE ends. Visit Complexity Inherent to Certain Office/Outpatient Evaluation and Management (E/M) (HCPCS code G2211)Īdditionally, we are finalizing the creation of a third temporary category of criteria for adding services to the list of Medicare telehealth services.Cognitive Assessment and Care Planning Services (CPT code 99483).Home Visits, Established Patient (CPT codes 99347-99348).Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT codes 99334-99335).Psychological and Neuropsychological Testing (CPT code 96121).Services added to the Medicare telehealth list on a Category 1 basis are similar to services already on the telehealth list: Medicare Telehealth and Other Services Involving Communications Technologyįor CY 2021, we are finalizing the addition of the following list of services to the Medicare telehealth list on a Category 1 basis. The PFS conversion factor reflects the statutory update of 0.00 percent and the adjustment necessary to account for changes in relative value units and expenditures that would result from finalized policies. With the budget neutrality adjustment, as required by law, to account for changes in RVUs including significant increases for E/M visit codes, the final CY 2021 PFS conversion factor is $32.41, a decrease of $3.68 from the CY 2020 PFS conversion factor of $36.09. Payment rates are calculated to include an overall payment update specified by statute.ĬY 2021 PFS Ratesetting and Conversion FactorĬMS is finalizing a series of standard technical proposals involving practice expense, including the implementation of the third year of the market-based supply and equipment pricing update, and standard rate-setting refinements to update premium data involving malpractice expense and geographic practice cost indices (GPCIs). These RVUs become payment rates through the application of a conversion factor. Relative value units (RVUs) are applied to each service for physician work, practice expense, and malpractice. Payments are based on the relative resources typically used to furnish the service. The technical component is frequently billed by suppliers like independent diagnostic testing facilities and radiation treatment centers, while the professional component is billed by the physician or practitioner. For many diagnostic tests and a limited number of other services under the PFS, separate payment can be made for the professional and technical components of services. In contrast, PFS rates paid to physicians and other billing practitioners in facility settings, such as a hospital outpatient department (HOPD) or an ambulatory surgical center, reflect only the portion of the resources typically incurred by the practitioner in the course of furnishing the service. For most services furnished in a physician’s office, Medicare makes payment to physicians and other professionals at a single rate based on the full range of resources involved in furnishing the service. Payment under the PFS is also made to several types of suppliers for technical services, often in settings for which no institutional payment is made. Physicians’ services paid under the PFS are furnished in a variety of settings, including physician offices, hospitals, ambulatory surgical centers, skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries’ homes. Since 1992, Medicare has paid for the services of physicians and other billing professionals under the PFS. The calendar year (CY) 2021 PFS final rule is one of several rules that reflect a broader Administration-wide strategy to create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation. On December 1, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates on policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2021.
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