Understanding How You Get Paid: Part 3

Once a CPT code has been reviewed by the American Medical Association (AMA) for valuation, the payment rates are determined by the Centers for Medicare & Medicaid Services (CMS). Let’s continue looking at the long-term EEG monitoring code set, which the AMA Relative Value Scale Update Committee (RUC) recently reviewed and sent recommended values to CMS.

The Medicare Physician Fee Schedule Proposed Rule, published by CMS in July, is the first public notice of a new code set, including the proposed payment rates. As the title implies, the rates are proposed by CMS and subject to public comment. The final payment rates, which take effect January 1, are included in the Medicare Physician Fee Schedule Final Rule.

Each year, the AAN carefully reviews the proposed payment rates and comments in objection to negative adjustments in an effort to maximize reimbursement for neurologic care.

The new code set for long-term EEG monitoring introduces significant changes to how the services are reported including the deletion of codes 95950, 95951, 95953, and 95956 and establishment of 23 new codes. Effective January 1, 2020, there will be 10 “professional component codes” to report the work of the physician or other qualified health care professional (QHP) and 13 separate “technical component codes” to report the work of the EEG technologist.

The professional component codes consist of the physician or QHP review, analysis, interpretation, and reporting the results of a continuous recording EEG, and are differentiated by three components:

Length of recording being interpreted
EEG recording with video vs. without video
Timing of the physician or QHP report generation: whether diagnostic interpretations and reports are made daily or whether the professional interpretation is performed at the end of the entire recording

The technical component codes consist of the technologist’s monitoring, maintenance, review of data, and creation of a technical summary of a continuous recording EEG and are also differentiated by three components:

Length of recording
EEG recording with video vs. without video
Level of technologist monitoring for the recording (i.e., unmonitored, intermittently monitored, or continuously monitored)

CPT^® is a registered trademark of the AMA. A full description of the code language and reporting guidelines is available at AAN.com/view/cpt. The 2020 payment rates for new CPT codes are published annually in November as part of the Medicare Physician Fee Schedule Final Rule. The final article in this series of AANnews coding articles will include 2020 reimbursement changes and coding guidance on how to use the new EEG code set.

Visit AAN.com/view/cpt to read the previous AANnews articles in this coding series.