Tag: AMA

2023-Medicare-Physician-Fee-Schedule

2023 Medicare Physician Fee Schedule on Unsustainable Cuts

Lower Medicare payments to physicians will lead to patient care by reducing access to services, according to medical groups commenting on the 2023 Medicare Physician Fee Schedule (PFS). In July, the U.S. Centers for Medicare & Medicaid Services (CMS) announced the 2023 proposed rule and physician groups have been responding, including with detailed comments published […]
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Prolonged Services in CPT versus Medicare

The code 99417 is invalid for Medicare and MA reimbursement. When the CPT® Guidelines were updated for 2021, one of the options for leveling an office or other outpatient evaluation and management (E&M) service was to use time as the leveling agent. The time thresholds for each E&M office visit were also changed from “typical” […]
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Prior-Authorization-Challenges

Prior Authorization Challenges Persist, AMA Survey Reveals

  Prior authorization still presents challenges to physicians, three years after the AMA and other health organizations released a consensus statement urging reform. A recent survey from the American Medical Association (AMA) evaluated the challenges and roadblocks of prior authorization (PA) for physicians and patients three years after a coalition of industry groups led by […]
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COVID-19 Antigen Testing

Coronavirus: AMA Releases New CPT Code for Antigen Tests

The American Medical Association (AMA) has released an update to the Current Procedural Terminology (CPT), introducing a new code for reporting antigen testing of patients suspected to be infected with COVID-19. Approved on June 25 during a meeting of the CPT Editorial Panel, this update signifies a milestone in expediting the review of proposed changes […]
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New 2020 CPT Codes Recognize E/M Work That Happens Online

Much attention is, rightly, going to the major overhaul of evaluation and management (E/M) office visit codes that will take effect in 2021 and is designed to reduce physicians’ documentation burden. But there are changes that have already taken effect Jan. 1, 2020, that acknowledge new ways of communicating with patients and practicing medicine that […]
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More Changes Ahead for Evaluation and Management Services

Changes to payment, coding, and documentation policies for evaluation and management (E/M) services finalized in the 2019 Physician Fee Schedule (PFS) final rule are necessary to align with the American Medical Association’s (AMA) revisions to the 2021 CPT code set for office/outpatient E/M visits, according to the Centers for Medicare & Medicaid Services (CMS). The proposed policy changes for E/M visits are […]
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AMA on Evaluation and Management Service Codes Guidelines for 2021

Medical coders who were unsure what documentation non-Medicare payers would expect in light of the Patients Over Paperwork Initiative now have more to go on. The initiative reduced documentation requirements for outpatient evaluation and management service codes (CPT® 99201-99215) provided to Medicare Part B patients beginning in 2021. The Centers for Medicare & Medicaid Services (CMS) indicated in their initiative that, although […]
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AMA Announces Evaluation and Management (E/M) Coding Changes

Q: Are there any updates on the Evaluation and Management code requirements? A: The American Medical Association (AMA) has now weighed in with their E/M coding requirement modifications, which means that all payers will be affected in 2021. If you remember, Medicare announced plans to revamp the E/M coding structure in 2018 and was met with […]
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ICD-10 Coding Errors, Diagnostic Errors, Payment Reform. Coding Errors

New ICD-10 Codes will help Physicians Tackle Social Barriers to Care

A new collaboration between the AMA and UnitedHealthcare will work to address the social and environmental factors that affect patients’ health by standardizing data collection on their social determinants of health (SDOH) to help address individuals’ unique needs that often go unmet. The two organizations are supporting the creation of 23 new ICD-10 codes related […]
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