Video EEG CPT Code 2021 Update

Twelve months ago, for those providing neurodiagnostic care to patients, the 2020 CPT code changes may have seemed like a huge bump in the road, and for many they were. In hindsight, we faced the much greater challenges presented with Covid-19. However, impacts from CPT coding were significant with threats to our ability to provide quality care for patients, but also to provide it in a safer in-home environment. Here's what you need to know about CPT code changes in 2021.

Some key CPT coding highlights and insights

  • Medicare Administrative Contractors (MACs) issued their rates at different points throughout the year, however the rules and reimbursement rates varied by MAC. 
  • After consultation with our coalition, some MACs made adjustments to better reflect the market, increasing their rates to be more in-line with equivalent coding in prior years.
  • State Medicaid programs gradually implemented support for the new codes, most at very low levels.
  • Private payors (insurance) aligned largely with MAC reimbursement levels, meaning that where a patient lives, now greatly impacts access to service.
  • APC code rates for hospital-based outpatient services were set on a national basis placing all the daily codes except for the continuously monitored video EEG code at the same reimbursement level. Even though these codes have significantly different levels of work and equipment requirements.

So where are we now in 2021?

Rates have somewhat stabilized. The CPT Industry Coalition continues to meet with and work with MACs and state Medicaid programs in an effort to smooth out regional reimbursement differences. In the final CMS ruling for 2021 there are no proposed changes impacting long term EEG recording, thus enabling continuity of care as we enter this new year. Covid continues to rage on, making safe outpatient treatment even more vital to create space for critical inpatient care. 

Our Coalition continues to fight for appropriate reimbursement for these important services through political activism and outreach, as well as directly approaching MAC and state Medicaid where there are significantly reduced reimbursements. Our goal is to maintain patient access to services  - no patient should be penalized based on where they live.

What can you do?

Here are a few tips to ensure you are optimizing coding and enhancing patient safety and quality:

  • Ensure you have documentation and audit trails to validate work performed.
  • Use the right EEG technology to optimize outpatient services deployed in a home setting.
  • Explore EEG software and hardware solutions that make achieving the new monitoring requirements possible.
  • Contact your state political leadership and representatives to have your voice heard if you are still in an area with reduced levels of reimbursement which is impacting patient access to services.

If you would like to download our latest CPT Code Guide, click here.

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