2021 brings more payer changes
By Carol Hoppe, CPC, CCS-P, CPC-I
There has been a lot going on with payers already in 2021, including the new E/M coding guidelines for office and outpatient procedure codes 99202-99215. Here are several important highlights with links to additional information.

Medicare PFS changes delayed
Among the many provisions impacting health care providers in the new COVID-19 relief package signed Dec. 28 is a moratorium on some changes to the Medicare Physician Fee Schedule. Specifically, the new evaluation and management “add-on” code (G2211) which was to begin in 2021 to account for added complexity in outpatient visits, has been delayed three years. This means that the full extent of expected Medicare cuts – including those for home visits – is also delayed, since the G-code would have triggered some substantial cuts to ensure budget neutrality. In addition, all providers will receive an increase of 3.75% in payments in 2021, along with a three-month delay in the automatic 2% cut due to “sequestration.”

Telehealth for COVID-19
The Centers for Medicare and Medicaid Services (CMS) will decline payments for audio-only patient visits beyond the public health emergency. The agency did, however, take several actions aimed at maintaining the momentum behind telehealth growth and the use of digital health tools. More than 150 codes have been added to the CMS Telehealth List, online here

E/M changes began Jan. 1
A new, two-page summary of the 2021 Evaluation and Management (E/M) changes that went into effect Jan. 1 is available online here. Page 1 is the information for coding based on TIME and Page 2 is just a large-print version of the new MDM table. You should also read the AMA’s 16-page document explaining the new definitions here.

Anthem BCBS updates
Anthem Blue Cross and Blue Shield (Anthem) recognizes all coding changes from both the AMA and CMS, including the E/M changes effective Jan. 1, 2021.
  • CPT code 99417 (prolonged services) and HCPCS Code G2212 (prolonged services) will be recognized as billable codes. These codes will be payable based on existing Prolonged Services policy, which will be updated to reflect the new codes along with the modifications to existing prolonged service CPT codes 99354 and 99355.
  • HCPCS Code G2211 (complexity inherent to evaluation and management associated with primary medical care) will not be separately reimbursed for this service, consistent with the new Medicare provisions noted above.
Anthem reimbursement policies impacted by the E/M service changes will be updated, such as the Documentation and Reporting Guidelines for Evaluation and Management Services.

New managed care entities
The Indiana Family and Social Services Administration’s (FSSA) Office of Medicaid Policy and Planning (OMPP) announced Anthem, Managed Health Services (MHS), and UnitedHealthcare will be the three managed care entities (MCEs) serving Hoosier Care Connect members effective April 1, 2021. (See BT2020124 Dec. 10, 2020