Billing and Coding Information
Effective from 1/1/2020
CPT 92201 will replace 92225
CPT 92202 will replace 92225
92201= with retinal drawing and scleral depression
92202 = with drawing of optic nerve or macula
92201 & 92202 are bilateral codes
Cataract Fees – 15% drop in physician reimbursement (AAO.org)
For Cataract Surgery, Medicare patients pay average $195 if done in ASC (Medicare.gov)
For Cataract Surgery, Medicare patients pay average $383 if done in Hospital Outpatient (Medicare.gov)
Keeping You In The Know
The field of Billing and Coding has constant changes, news, and updates. At MBS, we work through the insurance maze and keep you updated on all the news.
EFFECTIVE FROM 01/01/2021
- E/M exam code 99201 has been deleted.
- E/M exam level is now determined by either Time or MDM (Medical Decision Making)
- The three areas in Medical Decision Making are 1)Problem Addressed 2)Data Reviewed 3) Risk Management
- E/M level from using MDM is determined by meeting two out three of the above categories.
- For CPT 99211, ‘Time component has been removed’.
- Starting Jan. 1 2021, for some of the drugs, CMS will switch from “average sales price plus 6%” to a payment model calculated on “base price plus a flat fee”. The flat fee will be adjusted quarterly for inflation based on the lowest international price.
- Newly introduced CPT (category I codes) are : 76513 • 92227 • 92228 • 92229 • 99072.
- Medicare will not pay for CPT code 99072.
- Newly introduced CPT (category III codes) are:
0604T • 0605T • 0606T • 0615T • 0616T • 0617T • 0618T.
- New HCPCS G-codes for Virtual Check-Ins and Remote Video/Image Assessment in 2021 are
New Patient Code
Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient
Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, one or more visits
Established Patient Code
Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient
Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, one or more visits
Evaluation and Management Code Changes in 2021
Major changes are coming in E/M coding starting 2021. From 1/1/2021, 99201 will be deleted. Determination factors of levels of E/M code will drastically change as well. Guidelines for choosing the level of code will be more sensible and easy to follow. E/M codes will be chosen based on level of Medical Decision Making or Total Time Spent. Providers will no longer have to count different elements of the exam. This will reduce errors in up-coding or down-coding. Best news of all, fees for E/M codes will greatly increase, according to CMS.
E/M codes, starting January 1, 2021
New Patient Codes Established Patient Codes