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CMS Revises January 2021 Fee Schedule

CMS has announced they identified and corrected errors that were made when calculating and publishing the fee schedule that they released on December 11, 2020. Changes have been made to 920 code/modifier combinations (not 920 individual codes), and the majority of the changes are less than 1%. However, for roughly 70 code/modifier combinations (approximately 8% of the total combinations impacted), most of which use the KE modifier, the changes are more significant, ranging from a 30% decrease to a 57% increase. Rates in Alaska and Hawaii saw the greatest increases.

According to the CMS press release found here regarding these changes, “Claims submitted before January 26, 2021, with dates of service on or after January 1, 2021 may have been processed and paid using the incorrect fee schedule amounts…Suppliers may request that the DME MAC reprocess and adjust incorrectly paid claims for these HCPCS code/modifier combinations by providing their PTAN to the DME MAC. If the supplier makes this request, then all of the supplier’s claims affected by the erroneous fee schedule amounts (both overpayments and underpayments) will be reprocessed and adjusted. Please contact the DME MAC(s) for additional information about reprocessing.”

The updated and revised fee schedule(s), along with a full list of HCPCS codes that were impacted by these changes, can be found here.