EEG CPT Codes in 2021: Reimbursement Rates
The Neurodiagnostic CPT Coalition, of which Lifelines Neuro is a founding member, continues to advocate for fair EEG CPT rates to ensure equal access to care across the United States.
As we get further along in 2021, it is not expected that there will be any significant changes to the fee schedule or EEG CPT coding for Long Term EEG for the CMS 2022 Rule. This is good news for ongoing stability in reimbursement rates.
What to Watch
There are a few Medicare Administrative Contractor (MAC) outliers with lower reimbursement, however, there continues to be pressure to increase rates. There is a growing congressional effort to review and revise their rates to bring them in line with other MACs. Reportedly much of this low pricing is across the board, not just for LTM, so there is greater pressure beyond our sector to enact change. In the past MACs that consistently undervalue services have been known to lose their CMS contract.
Many state Medicaid programs base their valuation for services on the Medicare rates. They often take a reduced percentage across the board, for example, 45% of the Medicare rate. In some cases, it is possible to have Medicaid reimbursement set so low that it does not begin to cover the cost of providing the service. Likewise, private insurance often bases reimbursement on Medicare rates. Consequently, it is very important to challenge Medicare reimbursement valuations when they are out of touch with the reality of providing the service.
What Can You Do?
If you are in a region where either Medicare or Medicaid continues to undervalue the vital services that are provided to patients, consider contacting your state and local representatives to voice your concerns.
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