CMS Medicare Physician Fee Schedule final rule published

November 6, 2018

On November 1, 2018 the Centers for Medicare & Medicaid Services (CMS) released the 2019 Medicare Physician Fee Schedule (MPFS) final rule. It includes the following statement regarding the new Category I and revised Category III CPT codes for adaptive behavior services:

We note that we intended to assign a contractor price status in the Addendum B file of the proposed rule for the following CPT codes that describe adaptive behavior analysis services: CPT codes 97151, 97152, 97153, 97154, 97155, 97156, 97157, and 97158. These codes are formerly contractor priced Category III CPT codes that were converted to Category I for CY 2019. We inadvertently excluded these codes in the Addendum B file of the proposed rule, and have updated the Addendum B file for this final rule.
“Contractor price status” means that the new CPT codes will be priced by each payor for 2019. As always, providers should be prepared to negotiate reimbursement rates through the contracting process. Click here to access a document we have developed to assist providers with that process and other aspects of the transition to the new codes.