As CMS had proposed, it is increasing payments for Evaluation and Management (E&M) services but it is cutting most other services by 10.2% to maintain budget neutrality. Payments for the most common Interventional Cardiology procedures are dropping 9%. Below are some examples (with 2019 utilization numbers for interventional cardiologists).*
2021 Medicare Fee Changes for Top Interventional Cardiology Procedures |
|||||||
|
HCPCS |
MOD |
FACILITY |
SHORT DESCRIPTOR |
ALLOWED SERVICES (2019) |
2020 ALLOWED CHARGE |
2021 ALLOWED CHARGE |
CHANGE |
|
33361 |
62 |
Y |
Replace aortic valve perq |
23,059 |
$ 793 |
$ 723 |
-9% |
|
92928 |
|
Y |
Prq card stent w/angio 1 vsl |
109,256 |
$ 618.58 |
$ 564.56 |
-9% |
|
92978 |
26 |
Y |
Endoluminl ivus oct c 1st |
28,768 |
$ 98.89 |
$ 90.42 |
-9% |
|
93454 |
26 |
Y |
Coronary artery angio s&i |
55,865 |
$ 250.10 |
$ 228.16 |
-9% |
|
93455 |
26 |
Y |
Coronary art/grft angio s&i |
12,696 |
$ 291.24 |
$ 266.07 |
-9% |
|
93458 |
26 |
Y |
L hrt artery/ventricle angio |
185,200 |
$ 308.93 |
$ 281.63 |
-9% |
|
93459 |
26 |
Y |
L hrt art/grft angio |
34,519 |
$ 350.07 |
$ 319.22 |
-9% |
|
93460 |
26 |
Y |
R&l hrt art/ventricle angio |
35,191 |
$ 391.57 |
$ 357.47 |
-9% |
|
93571 |
26 |
Y |
Heart flow reserve measure |
33,893 |
$ 76.51 |
$ 69.35 |
-9% |
SCAI was successful in getting new codes paid for 2021. Sergio Bartakian, MD, FSCAI led the effort to get new codes for atrial septostomy (CPT codes 33741, 33745, 33746) and getting appropriate reimbursement rates for them as well. SCAI will have a webinar on these new congenital codes in early January 2021. New codes were also developed for percutaneous ventricular assist devices.
Interventional cardiologists do a lot of E&M services along with interventions and it is critical that members and their coders get up to speed on the revised and new E&M codes. Documentation requirements for many E&M services have been relaxed or eliminated. In addition, there are new add-on E&M codes for complex patients (G2211) and prolonged services (G2212). CMS estimates that interventional cardiologists will use these new add-on codes more than 200,000 times in 2021. Good sources of guidance on the E&M coding changes can be found at:
- The AMA offers resources to help physicians prepare for getting the full benefit of the burden relief from the E/M office visit changes, including a checklist, videos, modules, guidebooks, as well as other tools and references.
- CMS has a webinar on the E&M changes on December 10th from 1:30 pm ET to 3:00 pm. Free registration is here. Recordings of the webinar will be available here.
- ACC’s Medaxiom has some training available here as well, but that is not free to all.
Physicians and their staff need to adapt to these changes. Doing so should offset the procedures cuts significantly.
CMS’s press release on the new rule is here.
* Almost half of interventional cardiologists haven’t updated their CMS specialty code from general cardiology to interventional cardiology.