CMS Releases 2021 Medicare Physician Fee Schedule; ABA Codes Remain Carrier-Priced

August 27, 2020

The Centers for Medicare & Medicaid Services (CMS) released the proposed 2021 Medicare Physician Fee Schedule (MPFS) rule on August 17th. It can be found here. Addendum B, which contains all assigned relative value units (RVUs) for services within the MPFS, clearly indicates that the CPT codes for adaptive behavior (ABA) services (97151-97158, 0362T, 0373T) will remain carrier-priced (denoted by “C” in the status column in Addendum B). That means those codes have not been assigned RVUs and will most likely continue to be carrier priced by payers in 2021.  The final 2021 rule is expected this November, at which point the values and recommendations for 2021 will be final.  The Coalition will update providers when the final rule becomes available.