Add-on CPT Code and Value for 3D Echocardiography

Effective January 1, 2022, ASE was proud to see the establishment of Current Procedural Terminology (CPT) add-on code +93319.

This code describes the clinical work involved in 3D echocardiographic imaging and post-processing during transesophageal echocardiography, or during transthoracic echocardiography for congenital cardiac anomalies and includes the assessment of cardiac structures and function (cardiac chambers, valves, left atrial appendage, interatrial septum, and function for example), when performed.

To use this new add-on code and be reimbursed properly, you must list this new CPT code in addition to the appropriate base echocardiography code: congenital transthoracic (CPT codes 93303, 93304) or Transesophageal Echocardiography (CPT codes 93312, 93314, 93315, 93317). It is important to note that this is not an add-on code for CPT code 93355 since this code already includes 3D imaging for guidance of a structural intervention. CPT codes 76376 and 76377 are not add-on codes and are appropriate for reporting 3D-rendering services provided on a date separate from the base-imaging study.

This code, along with the RUC-recommended physician work RVU of 0.50, is now effective.

Often it takes time for commercial payers to review and support new technology codes/policies and the associated literature. The COVID-19 pandemic may delay the process even further. ASE suggests that providers always verify with the payers if authorization must be approved in advance.

Questions about coding? ASE provides members access to a coding expert. Log in to your ASE Member Portal and click “Advocacy,” then “Ask A Coding Expert” to submit your questions. ASE created a new coding newsletter with important information about changes in the CPT codes and policies in 2022.

US CMS CY 2022 Payment Rates Available for MPFS and HOPD

On November 2, 2021, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2022 Medicare Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (OPPS) Final Rules. The rules will be posted in the Federal Register no later than November 19, 2021.

Topline Takeaways

  • CMS finalizes payment rate for CPT code +93319
  • Four-year transition period to implement the clinical labor pricing update
  • CMS will extend, through the end of CY 2023, with the inclusion of certain Medicare telehealth services 

CY 2022 Medicare Physician Fee Schedule Final Rule

Conversion Factor & Impact to Echocardiography

Overall, the final CY 2022 PFS conversion factor is $33.59, a decrease of $1.30 from the CY 2021 PFS conversion factor of $34.89. The PFS conversion factor reflects the statutory update of zero percent and the adjustment necessary to account for changes in relative value units (RVUs) and expenditures that would result from our finalized policies. Congress intervened late last year to avert significant Medicare physician payment cuts this year, including providing a 3.75 percent payment increase that will expire at the end of 2021 unless Congress steps in again.

ASE continues to work in coalition with national and state medical societies urging Congress to act before January 1, 2022 to extend the existing 3.75 percent adjustment and prevent a Medicare sequestration, that will result in an across-the-board cut in Medicare provider payments, next year that could total as much as 6.0 percent. 

New Add-on CPT Code and Value for 3D

CMS finalized a work valuation of 0.50 RVUs for CPT code +93319 – 3D echocardiographic imaging and postprocessing during transesophageal echocardiography, or during transthoracic echocardiography. ASE is pleased that CMS accepted the AMA RUC recommendations for this service and wishes to thank Drs. Susan Mayer, Michael Main, Geoffrey Rose, Piers Barker, and Gregory Ensing for all their hard work. We could not have accomplished this without their efforts.

Clinical Labor Update

For the first time in nearly 20 years, CMS is updating the clinical labor rates that are used to calculate practice expense under the PFS. There will be a four-year transition period to implement the clinical labor pricing update, which will help maintain payment stability and mitigate any potential negative effects on healthcare providers by gradually phasing in the changes over time. ASE appreciates the four-year phase in of these changes to avoid future volatility within the fee schedule.

Telehealth Services under the PFS

CMS will continue to evaluate telehealth services that were temporarily added to the Medicare telehealth services list during the COVID-19 public health emergency (PHE). They have finalized an extension, through the end of CY 2023, for the inclusion of certain telehealth services temporarily added to the Medicare telehealth services list that would otherwise have been removed at the end of the COVID-19 PHE, or December 31, 2021. However, CMS has not officially extended the PHE and acknowledges there is uncertainty regarding the timing of their processes about the end of the PHE.

CY2022 Medicare Hospital Outpatient Prospective Payment Systems (OPPS) Final Rule 

Conversion Factor

In accordance with the Medicare statute, CMS is updating the CY 2022 OPPS payment rates for hospitals that meet applicable quality reporting requirements by 2.0 percent. This update is based on the projected hospital market basket increase of 2.7 percent, reduced by 0.7 percentage point for the productivity adjustment.

Use of CY 2019 Claims Data for CY 2022 OPPS Payment System Rate Setting Due to the PHE

CMS clarified that for the OPPS rate setting process, the best available data is used so that the payment rates can accurately reflect estimates of the costs associated with furnishing outpatient services. Ordinarily, the best available claims data is the most recent set of data, which would be from two years prior to the calendar year that is the subject of rulemaking. However, due to a number of COVID-19 PHE-related factors, CMS believes that the CY 2020 data are not the best overall approximation of expected outpatient hospital services in CY 2022. Instead, CMS believes the CY 2019 data, as the most recent complete calendar year of data prior to the COVID–19 PHE, are generally a better approximation of expected costs for CY 2022 hospital outpatient services for rate setting purposes. As a result, CMS is generally using CY 2019 claims data to set the CY 2022 OPPS payment system rates.

To view the Final CY 2022 Payment Rates – MPFS and HOPD, please log in to the ASE Member Portal and visit the Advocacy Portal page.

Below are links to CMS Fact Sheets for both rules.

Medicare 2022 Final Payment Policies Released

On November 2, 2021, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2022 Medicare Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (OPPS) Final Rules. The rules will be posted in the Federal Register no later than November 19, 2021.

Topline Takeaways

  • CMS finalizes payment rate for CPT code +93319
  • Four-year transition period to implement the clinical labor pricing update
  • CMS will extend, through the end of CY 2023, with the inclusion of certain Medicare telehealth services 

CY 2022 Medicare Physician Fee Schedule Final Rule

Conversion Factor & Impact to Echocardiography

Overall, the final CY 2022 PFS conversion factor is $33.59, a decrease of $1.30 from the CY 2021 PFS conversion factor of $34.89. The PFS conversion factor reflects the statutory update of zero percent and the adjustment necessary to account for changes in relative value units (RVUs) and expenditures that would result from our finalized policies. Congress intervened late last year to avert significant Medicare physician payment cuts this year, including providing a 3.75 percent payment increase that will expire at the end of 2021 unless Congress steps in again.

ASE continues to work in coalition with national and state medical societies urging Congress to act before January 1, 2022 to extend the existing 3.75 percent adjustment and prevent a Medicare sequestration, that will result in an across-the-board cut in Medicare provider payments, next year that could total as much as 6.0 percent. 

New Add-on CPT Code and Value for 3D

CMS finalized a work valuation of 0.50 RVUs for CPT code +93319 – 3D echocardiographic imaging and postprocessing during transesophageal echocardiography, or during transthoracic echocardiography. ASE is pleased that CMS accepted the AMA RUC recommendations for this service and wishes to thank Drs. Susan Mayer, Michael Main, Geoffrey Rose, Piers Barker, and Gregory Ensing for all their hard work. We could not have accomplished this without their efforts.

Clinical Labor Update

For the first time in nearly 20 years, CMS is updating the clinical labor rates that are used to calculate practice expense under the PFS. There will be a four-year transition period to implement the clinical labor pricing update, which will help maintain payment stability and mitigate any potential negative effects on healthcare providers by gradually phasing in the changes over time. ASE appreciates the four-year phase in of these changes to avoid future volatility within the fee schedule.

Telehealth Services under the PFS

CMS will continue to evaluate telehealth services that were temporarily added to the Medicare telehealth services list during the COVID-19 public health emergency (PHE). They have finalized an extension, through the end of CY 2023, for the inclusion of certain telehealth services temporarily added to the Medicare telehealth services list that would otherwise have been removed at the end of the COVID-19 PHE, or December 31, 2021. However, CMS has not officially extended the PHE and acknowledges there is uncertainty regarding the timing of their processes about the end of the PHE.

CY2022 Medicare Hospital Outpatient Prospective Payment Systems (OPPS) Final Rule 

Conversion Factor

In accordance with the Medicare statute, CMS is updating the CY 2022 OPPS payment rates for hospitals that meet applicable quality reporting requirements by 2.0 percent. This update is based on the projected hospital market basket increase of 2.7 percent, reduced by 0.7 percentage point for the productivity adjustment.

Use of CY 2019 Claims Data for CY 2022 OPPS Payment System Rate Setting Due to the PHE

CMS clarified that for the OPPS rate setting process, the best available data is used so that the payment rates can accurately reflect estimates of the costs associated with furnishing outpatient services. Ordinarily, the best available claims data is the most recent set of data, which would be from two years prior to the calendar year that is the subject of rulemaking. However, due to a number of COVID-19 PHE-related factors, CMS believes that the CY 2020 data are not the best overall approximation of expected outpatient hospital services in CY 2022. Instead, CMS believes the CY 2019 data, as the most recent complete calendar year of data prior to the COVID–19 PHE, are generally a better approximation of expected costs for CY 2022 hospital outpatient services for rate setting purposes. As a result, CMS is generally using CY 2019 claims data to set the CY 2022 OPPS payment system rates.

Below are links to CMS Fact Sheets for both rules.

New U.S. CPT codes for COVID-19

On September 8, the AMA CPT Editorial Panel published an update to the Current Procedural Terminology (CPT®) code set that includes two code additions for reporting medical services sparked by the public health response to the COVID-19 pandemic

The first code, CPT code 99072, was approved in response to sweeping measures adopted by medical practices and health care organizations to stem the spread of the novel coronavirus (SARS-CoV-2), while safely providing patients with access to high-quality care during in-person interactions with health care professionals. The additional supplies, materials and clinical staff time identified in this code are for items intended to mitigate the transmission of the respiratory disease for which the PHE was declared. The new code is to be reported only once per in-person patient encounter per day regardless of the number of services rendered at that encounter, allowing for the provision of extra precautions to ensure the safety of patients as well as health care professionals.

The second addition, CPT code 86413, was approved in response to the development of laboratory tests that provide quantitative measurements of SARS-CoV-2 antibodies, as opposed to a qualitative assessment (positive/negative) of SAR-CoV-2 antibodies provided by laboratory tests reported by other CPT codes. By measuring antibodies to SARS-CoV-2, the tests reported by 86413 can investigate a person’s adaptive immune response to the virus and help access the effectiveness of treatments used against the infection.

For quick reference, the two new Category I CPT codes and long descriptors are:

  • 99072: Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease.
  • 86413: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative

Please note CMS (or other payers) have not indicated they will cover these codes. ASE will monitor this very closely and update you on any developments

ASE Supports Healthcare Workers’ Mental Health in Next Coronavirus Aid Package

Earlier this month, ASE was contacted by U.S. Congressman Raja Krishnamoorthi’s office requesting support for providing mental health resources for frontline healthcare workers during the coronavirus pandemic and beyond. Healthcare workers are making enormous sacrifices every day to defeat this virus and ensuring access to the mental health resources needed is imperative. A bipartisan letter was sent to House leadership calling for the inclusion of enhanced mental health resources for healthcare workers in the next coronavirus aid package. ASE proudly supported this request that includes the establishment of a Department of Health and Human Services grant program to allow healthcare employers and facilities to confidentially assess and treat the mental health of frontline workers in addition to ordering a comprehensive study on healthcare workers’ mental health. This letter was signed by over 90 members of Congress and is supported by over 50 organizations. Read more here. ASE’s lobbyists are monitoring this bill, and we will report further developments as they arise.

 

New CMS Changes Just Issued – Parity in Payment for Telephone Services

Updated CMS Guidance Provides Parity in Payment for Telephone Services

Today, CMS announced that it will provide parity in payment for telephone services. Specifically, Medicare payment for the telephone evaluation and management visits would be equivalent to Medicare payment for office/outpatient visits with established patients retroactive to March 1, 2020. This would increase payments for these services from a range of about $14-$41 to about $46-$110.

ASE applauds CMS’s efforts to continue to provide more support for providers in the fight against COVID-19. This change in policy had been a priority for ASE and the Alliance of Specialty Medicine. Recently, as part of the Alliance, we sent CMS a letter highlighting the need for this change to support physician practices as they seek to deliver medically necessary care under unprecedented conditions.

The guidance updated today provides temporary regulatory waivers and new rules to maximum the flexibility in the response to COVID-19.

Telephone Evaluation, Management/Assessment and Management Services, and Behavioral Health and Education Services

  • A broad range of clinicians, including physicians, can now provide certain services by telephone to their patients.
  • Medicare payment for the telephone evaluation and management visits (CPT codes 99441-99443) is equivalent to the Medicare payment for office/outpatient visits with established* patients effective March 1, 2020.
  • When clinicians are furnishing an evaluation and management (E/M) service that would otherwise be reported as an in-person or telehealth visit, using audio-only technology, practitioners may bill using these telephone E/M codes provided that it is appropriate to furnish the service using audio-only technology and all of the required elements in the applicable telephone E/M code (99441-99443) description are met.
  • Using new waiver authority, CMS is also allowing many behavioral health and education services to be furnished via telehealth using audio-only communications.

Click here for the full list of telehealth services notes which services are eligible to be furnished via audio-only technology, including the telephone evaluation and management visits.

 *ASE is seeking clarification from CMS if this change includes new patients

Free ASE Coding Webinar

ASE is committed to making sure you have the resources need to thrive in today’s healthcare environment. Click here to access this FREE webinar,  2020 Reimbursement Updates Including the New Strain Code +93356. It is only 30 minutes long and focuses on the latest HOPPS and Physician Fee Schedule (PFS) changes to echo reimbursement and will help you prevent the most common errors in echo coding. A specific focus will be given to the new Myocardial Strain Imaging, CPT Code +93356.

Please feel free to share this with your colleagues and administrative staff.

Reimbursement Updates Including the New Strain Code +93356

Submission for MIPS 2019 Now Open and Check on Your 2020 Eligibility

CMS recently announced that the MIPS 2019 Data Submission Period is now open. MIPS eligible clinicians can start submitting data for 2019 through March 31, 2020. Also, you can now use the updated CMS Quality Payment Program Participation Status Lookup Tool to check on your initial 2020 eligibility for the Merit-based Incentive Payment System (MIPS). For more detailed information please click here. Interested in learning how ASE’s ImageGuideEcho™ Registry can help with future MIPS submissions? Contact Info@ImageGuideEcho.org for more information or to request a demonstration.

Myocardial Strain Imaging Add-on CPT Code and Live Webinar

ASE is proud to see the establishment of Current Procedural Terminology (CPT) add-on code +93356® to report myocardial strain imaging in conjunction with various transthoracic echocardiography procedures. The successful CPT application was a collaboration between ASE and the American College of Cardiology and will be effective for Medicare claims beginning today, January 1, 2020. This is the first new echo technology to achieve CPT editorial panel category 1 status in a decade! 

The code is intended to report myocardial strain imaging in conjunction with various transthoracic echocardiography procedures 93303, 93304, 93306, and 93308 in addition to stress echocardiography services 93350 and 93351. Additionally, the intent is for this code to be reported once per imaging session. Additional information on this code can be found on ASE’s Advocacy website.

Want to learn more? Join us for a live webinar on the 2020 Reimbursement Updates including the New Strain Code +93356, Friday, January 10, at 10:00 AM Eastern Time. The webinar will be presented by Michael Main, MD, FASE, ASE Advocacy Chair and RUC and CPT Advisor, and Denise Garris, ASE’s regulatory consultant and an expert in health policy and reimbursement.

This educational webinar will focus on the latest HOPPS and physician fee schedule (PFS) changes to echo reimbursement and help you prevent the most common errors in echo coding. Specific focus will be given to the new Myocardial Strain Imaging, CPT Code +93356. ASE would like to help the entire cardiovascular community, so this webinar is free for everyone. Please encourage your administrative and billing personnel to participate.  Register now to save your space. Specific questions regarding webinar registration can be sent to Jenn Goss at  JGoss@ASEcho.org.

ASE Is Here To Help You With Your Coding Questions

ASE is committed to providing our members with the tools and resources needed to ensure they are coding accurately, maintaining compliance with all requirements, and maximizing appropriate revenues.

Click here to see the most frequently asked coding questions. The 2019 ASE Coding Newsletter is now available. ASE also retains a coding expert that you may link to on-demand, directly through the Coding and Reimbursement page, available from both the Advocacy and Practice Management web pages.