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Panacea Unveils Comprehensive Summary of 2021 OPPS Final Rule

Following the recent unveiling by federal officials of the 2021 Outpatient Prospective Payment System (OPPS) Final Rule, Panacea Healthcare Solutions has created a comprehensive Final Rule Summary highlighting some of the most salient looming changes facing healthcare providers nationwide.

“The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) have been very busy updating coding and billing requirements throughout 2020 with the COVID-19 PHE (Public Health Emergency), and 2021 will be no different. Based on the 2021 OPPS Final Rule, there are 276 code additions, 224 code deletions, and 70 code descriptor modifications to be mindful of,” Panacea Senior Healthcare Consultant Tiffani Bouchard said.

Panacea’s Final Rule Summary

Panacea’s Final Rule Summary breaks out many details associated with the coding and billing under the OPPS for 2021, as well as a summary of the services associated with Communication Technology-Based Services (CTBS), which is discussed in the Medicare Physician Fee Schedule Final Rule for 2021, and COVID-19 vaccination and monoclonal antibody therapy, which is discussed in more detail in the CMS-9912-IFC Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency – and the CMS web page dedicated to vaccine and monoclonal antibody therapies.

Highlights of the Final Rule

Some additional highlights of the Final Rule, as outlined in Panacea’s Summary, include the beginning of the end for the Medicare Inpatient-Only List, which is being reduced by nearly 300 CPT/HCPCS codes, mostly for musculoskeletal-related services, as the first step in a three-year process that will ultimately result in the List’s complete dissolution. Additionally, the Final Rule featured sweeping changes to the APC (Ambulatory Payment Classification) Policy, addressing significant payment updates to approximately 5,400 CPT/HCPCS codes and implementing final payment methodology for 36 procedural and diagnostic services (excluding laboratory services).

Other highlights of the Final Rule included:

  • Newly finalized pass-through payment for devices such as the CustomFlex Artificial Iris (a prosthetic version of the eye membrane that controls pupil dilation); the EXALT duodenoscope (a device used for a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems); BAROSTIM NEO (an implantable device inserted near the carotid artery that reduces symptoms from heart failure); Hemospray (a single-use endoscopic hemostat used to treat non-variceal GI bleeds); and the SpineJack system (indicated for use in the reduction of mobile spinal fractures that may result from osteoporosis);
  • Updates to coding and billing policies during the COVID-19 PHE for non-physician staff performing non-evaluation and management services to registered hospital outpatients;
  • The exclusion of Multianalyte Assays with Algorithmic Analyses (MAAA) test codes from OPPS packaging policies and date-of-service requirements; these will now be separately paid under the Clinical Laboratory Fee Schedule (CLFS), and CMS is revising the list of test codes excluded from the OPPS packaging policy to include CPT codes 81500, 81503, 81535, 81536, 81539, and 81490; and
  • Changes to the level of supervision of outpatient therapeutic services in hospitals and critical access hospitals (CAHs); for 2021 and subsequent years, the minimum default level of supervision for non-surgical extended duration therapeutic services (NSEDTS) is being changed to general supervision for the entire duration of service.

Download Panacea’s Final Rule Summary in its entirety:

For more information on how Panacea is assisting providers nationwide with preparations for these and other changes, go online to