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Benchmark of the Week
With the Level 1 new patient office E/M code 99201 going away next year, it’s worth considering how your specialty performs with the other new patient office visit codes.
You can welcome a handful of triple-digit gainers among codes taking a fee increase in 2021. But such pay gains project to be something of an anomaly next year, according to code valuations CMS released alongside the proposed 2021 Medicare physician fee schedule.
You won’t find many plus signs on the list of “selected procedures” that CMS released alongside the proposed 2021 Medicare physician fee schedule. Except for E/M services, reduced fees dominate.
The extraordinary redistribution of allowable fees within the physician fee schedule is on pace to produce some crooked numbers in 2021. The payment outlook appears grim for a number of specialties whose reimbursement on top codes CMS proposes to reduce dramatically. Yet some specialties will still see gains.
Of the millions of procedures performed in place of service (POS) 11 (Office) every year, lesion-destruction services are some of the most frequently reported. Debriding nails and joint injections are other common non-E/M services.
Telehealth has emerged as a big part of American health care in the COVID-19 era, and in its early days some practices reported most of their visits being done by videoconference or phone. But a recent study from The Commonwealth Fund suggests that telehealth use may be trending down as practices reopen.
The ascendance of transitional care management (TCM) payments and claims may be slowing, but the codes (99495-99496) continue to maintain strong year-to-year growth, most recently reaping more than $186 million in Part B payments.
CMS’ 2018 Quality Payment Program (QPP) Experience Report that came out on July 7 suggests that Alternative Payment Models (APMs) are slowly gaining on traditional individual and group reporters and virtual groups are washing out.
Getting paid for more than one procedure on the same date of service was not much of a challenge for providers in recent years, judging by the claims data on modifier 51 (Multiple procedures).
The chances you're doing advance care planning (ACP) — reflected in 30-minute code 99497 and 30-minute add-on 99498 — depend a lot on your location. While Florida, Texas and California have the most claims overall, the encounters are likely to go on longer when conducted in the outer boroughs and suburbs of New York.


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