decisionhealth Newsletters, Part B News - 2020 Issue 12 (December)
2021 outlook: CMS takes aim at misvalued codes, retires group of NCDs
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Article Overview
This article summarizes CMS’s 2021 physician fee schedule actions on selected misvalued procedures, related valuation and global-period changes, and a set of Medicare coverage policy deletions and deferrals. It is relevant to coders, billing staff, physicians, and practice administrators who track Medicare reimbursement, CPT updates, HCPCS coding, and coverage policy changes.
Why This Topic Matters
The changes discussed can affect reimbursement, code valuation review, and coverage policy maintenance for practices that bill Medicare. It also highlights which code groups and NCDs CMS chose to retire, retain, or further evaluate for future rulemaking.
Article Sections
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Valuation of specific codes
Discussion of selected procedure codes under CMS valuation review, including payment and RVU-related changes and broader context from the AMA RUC.
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Removal of selected NCDs
Overview of Medicare coverage determinations CMS deleted or chose not to delete, including the general reasons cited for those policy decisions.
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Not establishing new code categories
Summary of CMS’s decision not to expand a related HCPCS code set at this time and the rationale described in the article.
What You Will Learn
- Which broad categories of Medicare payment changes were addressed for 2021
- How CMS approached selected procedure code valuation reviews
- What kinds of coverage policies were retired or retained
- How CMS handled proposed HCPCS code set expansion
- Which organizations were involved in reviewing these topics
Who Should Read This
- Medical coders
- Billing and reimbursement staff
- Physician practices
- Orthopedic and surgical specialties
- Compliance and revenue cycle professionals
Codes Discussed
Code Ranges Discussed
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