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April 2021 Update- Medicare Physician Fee Schedule - ATTN: All Billers!


This update applies to providers and facilities billing for services to Medicare patients through billing MACs (Medicare Administrative Contractors) using the Medicare Physician Fee Schedule.


There are new HCPCS Level II codes. This code set is used for reporting products, supplies, and services. Three are 23 new codes, 6 codes that have been revised, and 12 codes that have been discontinued.


Some of the specialties impacted are urology, orthopedics, dermatology, and ophthalmology.


Some of the changes are as follows:


Code Long Descriptor OPPS SI APC

A9592 Copper cu-64, dotatate, diagnostic, 1 millicurie G 9383

C9074 Injection, lumasiran, 0.5 mg G 9407

C9777 Esophageal mucosal integrity testing by electrical impedance, transoral (list separately in addition to code for primary procedure) N

G2020 Services for high intensity clinical services associated with the initial engagement and outreach of beneficiaries assigned to the sip component of the pcf model (do not bill with chronic care management codes)

G2172 All inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project

J1427 Injection, viltolarsen, 10 mg G 9386

J1554 Injection, immune globulin (asceniv), 500 mg G 9392

J7402 Mometasone furoate sinus implant, (sinuva), 10 micrograms G 9346

J9037 Injection, belantamab mafodontin-blmf, 0.5 mg G 9384

J9349 Injection, tafasitamab-cxix, 2 mg G 9385

K1013 Enema tube, any type, replacement only, each

K1014 Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control

K1015 Foot, adductus positioning device, adjustable

K1016 Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve

K1017 Monthly supplies for use of device coded at k1016

K1018 External upper limb tremor stimulator of the peripheral nerves of the wrist

K1019 Monthly supplies for use of device coded at k1018

K1020 Non-invasive vagus nerve stimulator

M0245* Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring

Q0245* Injection, bamlanivimab and etesevimab, 2100 mg

Q2053 Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose

S1091 Stent, non-coronary, temporary, with delivery system (propel)


The discontinued HCPCS Level II codes are as follows:


C9068 Copper cu-64, dotatate, diagnostic, 1 millicurie

C9069 Injection, belantamab mafodontin-blmf, 0.5 mg

C9070 Injection, tafasitamab-cxix, 2 mg

C9071 Injection, viltolarsen, 10 mg

C9072 Injection, immune globulin (asceniv), 500 mg

C9073 Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose

C9122 Mometasone furoate sinus implant, 10 micrograms (sinuva)

J7333 Hyaluronan or derivative, visco-3, for intra-articular injection, per dose

J7401 Mometasone furoate sinus implant, 10 micrograms

K1010 Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each

K1011 Activation device for intraurethral drainage device with valve, replacement only, each

K1012 Charger and base station for intraurethral activation device, replacement only


The revised HCPCS Level II codes are as follows:


C9761* Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy, and ureteral catheterization for steerable vacuum aspiration of the kidney, collecting system, ureter, bladder, and urethra if applicable

G9868 Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, less than 10 minutes

G9869 Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, 10-20 minutes

G9870 Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, more than 20 minutes

J7321 Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose


Have more questions, need more information?


https://www.cms.gov/files/document/mm12155.pdf

https://www.cms.gov/files/document/mm12175.pdf

https://www.cms.gov/files/document/r10631cp.pdf


Provided by: Melanie Puccella, melanie@billingllc.com, 713-533-4222

www.billingllc.com







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