Providers
gained a substantial pay boost for audio-only E/M encounters (
99441-
99443) under recent CMS rulemaking -- and the path to those payments for claims you already submitted just got easier.
In a May 15 provider email update, CMS announced that regional Medicare administrative contractrors (MAC) "will reprocess claims for those services that they previously denied and/or paid at the lower rate."
If you've been performing audio E/M encounters and reporting 99441-99443 claims, know that MACs will automatically revisit your claims and adjust payments as necessary. "You do not need to do anything," CMS said.
CMS issued revisions to the physician fee schedule, including larger payments for the telephone E/M codes, on April 30. However, the payment edits are retroactive to March 1, 2020. That means any 99441-99443 claims that you submitted since the March 1 cut-off date should return upwardly revised payments.
Example: Instead of the $14 you would have been paid for 99441 claims, your reprocessed payment
will be in the ballpark of $46. Payments for 99442 will rise to $76, up from $28, and 99443 claims will clear $110, up from $41. The new payment rates for the audio E/M codes are on par with established office visit codes
99212-
99214.
In a related passage from the May 15 provider update, CMS also said it has instructed MACs to reprocess claims for "a number of add-on services" that providers may have billed -- and that "Medicare may have denied" -- during the COVID-19 public health emergency.
The agency specifically lists the following services, which include psychotherapy codes, prolonged E/M services and chronic care management, among others:
- 90785 (Interactive complexity [List separately in addition to the code for primary procedure]).
- 90833 (Psychotherapy, 30 minutes with patient when performed with an E/M service [List separately in addition to the code for primary procedure]).
- 90836 (Psychotherapy, 45 minutes with patient when performed with an evaluation and management service[List separately in addition to the code for primary procedure]).
- 90838 (Psychotherapy, 60 minutes with patient when performed with an evaluation and management service [List separately in addition to the code for primary procedure]).
- 96160 (Administration of patient-focused health risk assessment instrument [eg, health hazard appraisal] with scoring and documentation, per standardized instrument).
- 96161 (Administration of caregiver-focused health risk assessment instrument [eg, depression inventory] for the benefit of the patient, with scoring and documentation, per standardized instrument).
- 99354 (Prolonged E/M t or psychotherapy service; first hour [List separately in addition to code for office or other outpatient Evaluation and Management or psychotherapy service]).
- 99355 (Prolonged E/M or psychotherapy service; each additional 30 minutes [List separately in addition to code for prolonged service]).
- G0506 (Comprehensive assessment of and care planning for patients requiring chronic care management services [list separately in addition to primary monthly care management service]).
CMS instructed MACs to reprocess denied claims reported after March 1 for the above services.