CMS: Reminder! Summary of changes in the 2021 Medicare Physician Fee Schedule rule. 

There are changes in the 2021 Medicare Physician Fee Schedule rule, including the new CPT coding rules of office/outpatient E/M visits. To know more, read along!

a.       Physicians and NPPs, including therapists, can review and verify documentation entered into the medical record by members of the medical team for their own services that are paid under the MPFS;
b.       Therapy students, and students of other disciplines, working under a physician or practitioner who furnishes and bills directly for their professional services to the Medicare program, may document in the record so long as it is reviewed and verified (signed and dated) by the billing physician, practitioner, or therapist.

  • Therapy Assistants Furnishing Maintenance Therapy: PTs/OTs are allowed to delegate the furnishing of maintenance therapy services, as clinically appropriate, to PTAs/OTAs
  • Office/Outpatient E/M Visits: Under new CPT coding framework, history and exam will no longer be used to select the level of code for office/outpatient E/M visits. Instead, an office/outpatient E/M visit will include a medically appropriate history and exam, when performed. CPT code 99201 is deleted. For levels 2 through 5 office/outpatient E/M visits, selection of the code level to report will be based on either the level of medical decision making, or the total time personally spent by the reporting practitioner on the day of the visit (including time with and without direct patient contact).
  • Prolonged Office/Outpatient E/M Visits: HCPCS code G2212 is to be used instead of CPT code 99358, 99359 or 99417, with the following descriptor: “Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (List separately in addition to CPT codes 99205, 99215 for office or other outpatient evaluation and management services).


Source: https://www.cms.gov/files/document/mm12071.pdf


For more details refer to our December issue.