CMS Releases 2020 Proposed Medicare Physician Fee Schedule Rule; Suggests No Change for ABA Codes

On July 29, 2019 the Centers for Medicare & Medicaid Services (CMS) released their annual notice of proposed rulemaking (NPRM) for the Medicare Physician Fee Schedule (MPFS). As providers may know, these annual proposed and final rule notices are where CMS publishes modified policies and reimbursement rates for all medical services within the MPFS. In the July 29 notice, CMS did not propose any changes regarding the CPT codes for adaptive behavior (ABA) services, nor did they propose to alter the current status of those codes as “carrier priced.” So if approved within the final rule (typically issued on or around November 1 each year), those codes will not have assigned relative value units, and reimbursement rates for the services will continue to be determined by each payer (CMS or commercial health plan) through the normal contract and negotiation process for 2020. Should you have any questions about this update or the NPRM generally, please email us.