Advocacy

Billing & Coding

2020 Medicare Physician Fee Schedule Summary 

On November 1, 2019, the Centers for Medicare and Medicaid Services (CMS) released the Final Rule that makes revisions to the CY 2020 payment policies under the Medicare Physician Fee Schedule (PFS) and other policy changes, including those required to implement certain provisions of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (the SUPPORT Act) related to Medicare Part B payment. 

CMS has also published a fact sheet on the PFS Final Rule for 2020.  

Three sections of the Final Rule are particularly relevant to ASAM members and are summarized below: 

In addition, the Final Rule aligns Medicare E/M coding with changes adopted by the American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel for new and existing patient office E/M visits. A summary of those changes can be found here. The AMA built an educational website dedicated solely to the E/M changes, available here, which will be updated during the year. CMS also adopted the AMA Specialty Society Relative Value Scale Update Committee (RUC) recommended values for the office E/M visit codes for CY 2021 and the new add-on CPT code for prolonged service time. The AMA RUC-recommended values are anticipated to increase payment for office E/M visits.

CPT Codes Now Provide for Separate Reimbursement for “Interprofessional Telephone/Internet/Electronic Health Record Consultation”

There are now separately reimbursable “Interprofessional Telephone/Internet/Electronic Health Record Consultation” CPT codes that describe assessment and management services furnished when a patient’s treating physician or other qualified health care professional (OQHCP) requests the opinion and/or treatment advice of a physician (or OQHCP, if eligible) with specialty expertise (the consultant) to assist in the diagnosis and/or management of the patient’s problem without the patient’s face-to-face contact with the consultant.  The American Psychiatric Association (APA) has created resources for psychiatrists about these codes. Read more here on the APA's website. (See APA’s first bullet point under “Codes to Know”.)

ASAM Letter for Non-Psychiatrist Addiction Specialists

Given the wide treatment gap among patients needing treatment and the doctors available to treat them, ASAM recommends that payers should add non-psychiatrist addiction specialist physicians certified by the ABPM, ABAM, ASAM, and AOA and non-psychiatrist physicians who have completed an accredited residency/fellowship in addiction medicine to their in-network provider panels to treat patients diagnosed with a substance use disorder (SUD). ASAM is happy to provide this letter as a resource for non-psychiatrist addiction specialists experiencing exclusion from provider panels in public and/or private payers networks. Please contact ASAM Staff at advocacy@asam.org for assistance using this form letter.

Download Letter

ICD-10 Transition Resources

To be properly reimbursed, accurate descriptions of the service being provided are needed. Billing codes, including CPT, are used to describe the procedure or treatment being provided, in order to be adequately reimbursed for practice expenses and physician effort. ICD-10 codes are used to describe the diagnosis that brings the patient to seek care.

 In new guidance, CMS announced:

  • For a one year period starting October 1, Medicare claims will not be denied solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes.  In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes.  This policy will be followed by Medicare Administrative Contractors and Recovery Audit Contractors. 
  • To avoid potential problems with mid-year coding changes in CMS quality programs (PQRS, VBM and MU) for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores (i.e., for PQRS, VBM, or Meaningful Use). CMS will continue to monitor implementation and adjust the duration if needed. 
  • CMS will establish an ICD-10 Ombudsman to help receive and triage physician and provider problems that need to be resolved during the transition. 
  • CMS will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation. 

 See these documents and websites for more information: 

ICD-10 FAQ from CMS 

American College of Physicians: ICD-10 Tips

Taxonomy Codes for Addiction Specialist Physicians

Taxonomy Code FAQ