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By Eric Oliver for Becker’s Hospital Review
With the new calendar year, several CMS changes took effect, with more on the way. Here’s a roundup of changes CMS made or will make in 2021:
- Removed 298 musculoskeletal-related services. By 2024, all 1,700 procedures on the inpatient-only list will be phased out, and will be allowed to be performed in the outpatient setting when clinically appropriate.
- Made 11 additions to the list of procedures payable in the ASCs. Those are:
- CPT code 27130: Total hip arthroplasty
- 0266T: Implantation or replacement of carotid sinus baroreflex activation device; total system (includes generator placement, unilateral or bilateral lead placement, intra-operative interrogation, programming and repositioning, when performed)
- 0268T: Implantation or replacement of carotid sinus baroreflex activation device; pulse generator only (includes intra-operative interrogation, programming and repositioning, when performed)
- 0404T: Transcervical uterine fibroid(s) ablation with ultrasound guidance, radiofrequency
- 21365: Open treatment of complicated fracture(s) of malar area, including zygomatic arch and malar tripod; with internal fixation and multiple surgical approaches
- 27412: Autologous chondrocyte implantation, knee
- 57282: Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, iliococcygeus)
- 57283: Colpopexy, vaginal; intra-peritoneal approach (uterosacral, levator myorrhaphy)
- 57425: Laparoscopy, surgical, colpopexy (suspension of vaginal apex)
- C9764: Revascularization, endovascular, open or percutaneous, any vessel(s); with intravascular lithotripsy, includes angioplasty within the same vessel(s), when performed
- C9766: Revascularization, endovascular, open or percutaneous, any vessel(s); with intravascular lithotripsy and atherectomy, includes angioplasty within the same vessel(s), when performed
- Migrated 267 procedures to the ASC-payable list, and moved to allow the public to suggest future additions to the list.
- Updated the payment rate for all covered procedures by 2.4 percent. However, the update for specific codes and specialties may vary.
- Lowered the physician fee schedule conversion factor for 2021 to $34.89, down 3.3 percent from $36.09 in 2020.
- Will pivot to using prior authorization for patients to undergo cervical fusion with disc removal and implanted spinal neurostimulators beginning July 1.
- Added more than 60 services to Medicare’s telehealth list. The procedures were temporarily added at the beginning of the pandemic to ensure they were covered, but this will continue to cover them after the public health emergency concludes.
- Allowed certain nonphysician practitioners to supervise diagnostic testing if state law allows.
- Increased the reimbursement physicians receive from performing Vertos Medical’s minimally invasive lumbar spinal stenosis procedure. CMS increased the percent physicians are reimbursed by 41 percent.
- Created a guideline for in-development blood-based colorectal cancer screening tests to earn approval.