AASM analysis of CMS interim final rules on virtual check-in services and PPE

The 2021 Medicare Physician Fee Schedule final rule also contained two interim final rules with public comment addressing payment for virtual check-in services and coding and payment for personal protective equipment. The AASM submitted a comment letter to CMS in response to these rules (file code CMS-1734-IFC).

The following summary of the interim final rules is provided for AASM members, who may send questions regarding this document to coding@aasm.org.

Interim Final Rule with Comment:  Coding and Payment for Virtual Check-in Services

Given the widespread concerns expressed by providers about the continuing need for audio-only conversations with patients, for calendar year (CY) 2021, on an interim basis, CMS has established the following Healthcare Common Procedure Coding System (HCPCS) code:

• G2252: Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion

CMS believes this will support access to care for beneficiaries who may be reluctant to return to in-person visits unless absolutely necessary and will allow the agency to consider whether this policy should be adopted on a permanent basis. CMS finalized a crosswalk to CPT code 99442 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion), which reflects the resources associated with a longer service delivered via synchronous communication technology and can include audio-only communication. There is some additional time included to determine the necessity of an in-person visit. 

In the case of HCPCS code G2252, the additional time would be used to determine the necessity of an in-person visit resulting in a work time/intensity that is similar to the crosswalk code. This is not a substitute for an in-person visit, but rather an assessment to determine the need for one, and the only technological requirement is that the communication technology must be synchronous. If this service originates from a related E/M service provided within the previous 7 days or leads to an E/M service or procedure within the next 24 hours or soonest available appointment, then it would be considered bundled into that in-person service.

CMS found that it would be impracticable and contrary to the public interest to undergo notice and comment procedures before finalizing these payment policies on an interim basis, so any comments submitted regarding the HCPCS code would inform payments for calendar year 2022 and beyond.

CMS is providing a 60-day public comment period for this interim final rule. While CMS is not requesting any specific information regarding the establishment of the code, the AASM will consider the necessity of the code as well as whether the crosswalk to CPT code 99442 is appropriate.

Interim Final Rule with Comment: Coding and Payment for Personal Protective Equipment (PPE)

In September, after work with many medical specialty societies, the AMA finalized a CPT code 99072, intended for reporting additional supplies and clinical staff time required to provide safe and effective care during the COVID-19 public health emergency. The code was subsequently submitted to CMS, along with a request for immediate implementation. CMS has now finalized CPT code 99072 as a bundled service on an interim basis, believing that use of the additional forms of PPE would be inherent to the furnishing of separately paid services under these practitioner/patient interactions. CMS agrees that there have been additional costs for providers as part of the public health emergency for COVID-19; however, CMS notes that payment for the services as described under CPT code 99072 are always bundled into payment for other services, and payment for them is subsumed by the payment for the services to which they are incident.

The following supply pricing increases are being finalized, on an interim basis, based on the supply invoices submitted by the AMA:

• The N95 mask is being added to the supply database under supply code SD344 at the median price of $2.36.
• CMS is increasing the price of the surgical mask to the median price of $0.43.
• CMS is increasing the price of the surgical mask with face shield to the median price of $3.40.

Despite receiving invoices associated with non-sterile gloves, nitrile gloves, patient gowns, and sterile surgical gowns, CMS is not finalizing changes in the prices of these supplies at this time due to concerns regarding the data on the submitted invoices. The non-sterile gloves and nitrile gloves contained median prices that were significantly lower than their CY 2021 prices. The sterile surgical gowns followed the same pattern. CMS does not believe that the typical price for these supplies has undergone significant decreases because of the public health emergency and is, therefore, not finalizing any price changes at this time pending additional discussion with stakeholders. For the patient gown, CMS is not finalizing a price change since the invoice data suggested that the current price remains typical during the public health emergency. CMS also received a small quantity of invoices associated with other PPE supplies but did not believe there was enough data in these cases to determine typical pricing; therefore, the agency is not finalizing any additional price changes to supply items. CMS also does not have the authority to waive budget neutrality for 99072.

CMS is providing a 60-day public comment period for this interim final rule. The agency is specifically seeking comments on the general approach to CPT code 99072, as well as how to think about services that may not include these specific PPE items but for which there are incurred costs as described by the stakeholders. Additionally, CMS will consider the market cost for the supply items relative to the changing conditions in the market, as appropriate.

Updated Feb. 5, 2021