On December 1, 2020, about a month later than the normal schedule, CMS released final rulemaking for the Physician Fee Schedule and related policies for CY2021.
The CMS press release focused on expanded telehealth services and better payments for E&M services in primary care.
- See the press release here.
- See the Fact Sheet here.
- See the "inspection copy" or typescript rule here.
- It weighs in at over 2000 pages.
- Look for the Fed Reg final rule here on Dec 28.
- See some missing paragraphs and updates in Fed Reg Jan 2021, here.
- Trade journal Healthcare Dive here.
- "CMS extends telehealth rules, cuts specialty rates."
- NCD Deletion
- Pricing of per click fees for AI software
- Pricing of the iRhythm service
Separately, CMS on September 16 published an update on its backlog of NCD requests. Here. There are 0 requests under review, 3 on a wait list (diaphragm pacemakers, pulmonary pressure sensor for CHF, ventilators for COPD), 6 NCD requests open, and 2 NCDs finalized in the past 12 months. CMS also reports NCD activities to Congress, e.g. in 6/2019 they reported on 2018 activities (here). Related, it looks like CMS held 2 MEDCACs in 2018, 0 in 2019, and 1 in 2020 (here). There hasn't been an NCD Appeal since 2014 (here).
ROYALTIES FOR AI-BASED SERVICES (PER CLICK FEES)
An interesting code is on page 489ff (typescript), 92229, imaging of retina with remote point of care automated analysis which "uses artificial intelligence technology." An image analysis fee (e.g. a per click fee or royalty fee) was proposed as part of the business model for the technology. CMS declined to value this. They write, "While we agree that the costs of AI applications should be accounted for in payment, AI applications are not well accounted for in our practice expense methodology."
These rules are normally released by November 1, to allow 60 days for implementation both at CMS and at providers, prior to January 1.