Wiki CMS Policy for new 2021 E/M changes

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Anduiza05

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Hello,

Does anyone know where I can find the final policy for CMS changes to the new 2021 E/M AMA outpatient codes? I am in the process of training our physicians but our EMR software provider released this statement in regard to the templates created for the new changes. "To provide flexibility — Per the CMS, you can choose to follow the new guidelines for 2021 or to continue using 1995 or 1997 guidelines." I have not seen anything from CMS stating that they will have flexibility when choosing the new 2021 outpatient E/M codes. I think they are confusing the inpatient (staying the same) with the new outpatient changes. I think I could clear this up with a policy but not sure if CMS has released as of yet. Any advice on how I can locate this information or the actual policy from CMS?

Thank you!
 
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Anduiza05 said:
Hello,

Does anyone know where I can find the final policy for CMS changes to the new 2021 E/M AMA outpatient codes? I am in the process of training our physicians but our EMR software provider released this statement in regard to the templates created for the new changes. "To provide flexibility — Per the CMS, you can choose to follow the new guidelines for 2021 or to continue using 1995 or 1997 guidelines." I have not seen anything from CMS stating that they will have flexibility when choosing the new 2021 outpatient E/M codes. I think they are confusing the inpatient (staying the same) with the new outpatient changes. I think I could clear this up with a policy but not sure if CMS has released as of yet. Any advice on how I can locate this information or the actual policy from CMS?

Thank you!
Click to expand...
Hello,

You can find the proposed rule for the Medicare Physician Fee Schedule at https://www.cms.gov/medicaremedicar...chedpfs-federal-regulation-notices/cms-1734-p where CMS confirms their intent to adopt the new CPT guidelines as stated in the final rule for the 2020 fee schedule. There is no option to continue to use the 1995 or 1997 guidelines for codes 99202-99205 and 99212-99215 because the codes no longer align with those guidelines. The vendor may have gotten this confused as CMS had previously proposed their own plan for revising guidelines and payment for office E/M services and did allow for continued use of the 1995 and 1997 guidelines under that proposal. However, CMS abandoned that proposal in favor of the new CPT code revisions and guidelines.

I hope that is helpful.
Cindy
 
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Cynthia Hughes said:
Hello,

You can find the proposed rule for the Medicare Physician Fee Schedule at https://www.cms.gov/medicaremedicar...chedpfs-federal-regulation-notices/cms-1734-p where CMS confirms their intent to adopt the new CPT guidelines as stated in the final rule for the 2020 fee schedule. There is no option to continue to use the 1995 or 1997 guidelines for codes 99202-99205 and 99212-99215 because the codes no longer align with those guidelines. The vendor may have gotten this confused as CMS had previously proposed their own plan for revising guidelines and payment for office E/M services and did allow for continued use of the 1995 and 1997 guidelines under that proposal. However, CMS abandoned that proposal in favor of the new CPT code revisions and guidelines.

I hope that is helpful.
Cindy
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Hi Cindy,
Thank you for this information. Do you know what categories the policy is located? CMS has so many files to download and I am in the weeds trying to find it :(
Theresa
 
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Anduiza05 said:
Hi Cindy,
Thank you for this information. Do you know what categories the policy is located? CMS has so many files to download and I am in the weeds trying to find it :(
Theresa
Click to expand...
Choose the link to the rule that is at the bottom of the page under related links. The rule is a big PDF file but you can find the information you need starting on page 50122. Cindy
 
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