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Benchmark of the Week
Medicare Part B claims for most E/M office visits (99201-99215) reported with place of service (POS) 11 (Office) dipped in 2020 compared to claims submitted in 2019. Claims for these services fell by a total of 42.5 million visits year to year, with 99211 being the only code that experienced an increase — of 243,990 claims — during the first year of the COVID-19 public health emergency (PHE).
As in-person E/M visits cratered during the first year of the COVID-19 health crisis, practices successfully turned to phone-based encounters (99441-99443) and brought in millions in payments.
More widespread use of chronic care management (CCM) services elevated the code family to all-time highs in total claims and payments in 2020, which bodes well for providers who will find lucrative pay gains after Jan. 1.
Despite returning significantly fewer payments for a series of core E/M office visit codes in 2020, nurse practitioners (NP) and physician assistants (PA) continued to gobble up a greater share of E/M claims in comparison to their Medicare-billing peers in other specialties.
The COVID-19 pandemic appears to have severely hit the Medicare Diabetes Prevention Program (MDPP) in 2020, with claims dropping to less than half of what they were in 2019. The decreased volume comes despite a range of CMS flexibilities and marks another ominous sign for the underperforming program.
You’ll find lucrative pay gains among a series of chronic care management (CCM) services in CY2022, as CMS seeks to expand their use. Yet not all fee changes are as propitious. Dozens of codes are taking fee hits, including a series of gastrointestinal services.
The numbers contained in CMS’ short list of high-volume codes are even less rosy than this year’s earlier proposal, with harsher payment cuts coming in CY 2022.
While the 4% cut to the 2022 conversion factor is coming for all specialties, the impact of relative value unit (RVU) changes harbors its own outlook – fluctuating from a 6% gain for diagnostic testing facility to a -5% drop for interventional radiology and vascular surgery.
Get ready to sharpen your claims billing when the calendar flips to 2022 by adapting to a slate of CPT code revisions. Of the hundreds of CPT code changes taking effect Jan. 1, you’ll find 93 revised codes, many of which are impacting oft-reported services.
Most virtual encounters during the COVID-induced telehealth spike involved patients who had an established relationship with a provider, and that detail may influence federal policymaking on the future coverage of tech-enabled visits, according to an OIG analysis released Oct. 20.


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