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Benchmark of the Week
The outlook on E/M office visit payments was looking strong heading into 2021, but recent fee changes are on track to supercharge those services.
The most-used modifiers list didn’t change much in 2019 compared to the previous year — except for one particular modifier used in multi-line billing.
While 2020 will always be remembered for the COVID-19 pandemic and the mass casualties and despair around the nation and the world, the lasting effects of the virus are also likely to reshape the delivery of health care in myriad ways. One of the lasting changes may be the vast expansion of telehealth services.
Among the documents related to the final 2021 Medicare physician fee schedule that should interest practices is the “Impact on CY 2021 payment for selected procedures” chart, showing the estimated impact of reimbursement changes on procedures chosen by CMS “from among the procedures most commonly furnished by a broad spectrum of specialties.”
It’s a topsy-turvy fee outlook in 2021, as medical practices are projected to see wild fluctuations in Part B charges in the new year. With specialty-specific gains reaching as high as 16% – and losses also reaching double digits – your billing patterns are likely to tell how your Medicare charges will fare.
Considering its stringent requirements, you may expect claims with modifier 24 (Unrelated E/M service during a postoperative period) to see a lot of denials. But their rates are actually very low, especially compared to where they were four years earlier.
The critical care code set may be small in size, consisting of two CPT codes (99291, 99292), but it packs a wallop when it comes to provider revenue. In 2019, practices surpassed the $1 billion mark in payments tied to the two codes.
CMS released its Part B claims numbers for 2019 on Nov. 5, and the yearly numbers show nearly everything growing except two areas: denial rates and E/M utilization.
Check the time and other possible billing hazards for advance care planning (ACP) claims. The two ACP codes (99497, 99498) show an average denial rate of 19% since Medicare started covering the service, which may be a sign that practices are making easy-to-avoid mistakes for the two codes.
Provider payments for two psychiatric diagnostic evaluation codes (90791, 90792) maintained steady growth in recent years, returning more than $140 million in fees in 2018, the latest year of available Medicare claims data.


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