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NEW 2021 CPT Code Set released by the AMA

American Medical Association (AMA) reported that is has published the first major overhaul in more than 25 years to the codes and guidelines for office and other outpatient evaluation and management (E/M) services in the release of the 2021 Current Procedural Terminology (CPT) code set.

These foundational modifications were designed to make E/M office visit coding and documentation simpler and more flexible, freeing physicians and care teams from clinically irrelevant administrative burdens. The changes to CPT codes ranging from 99201-99215 are proposed for adoption by the Centers for Medicare and Medicaid Services on Jan. 1, 2021.

The E/M office visit modifications include:

  • Eliminating history and physical exam as elements for code selection.
  • Allowing physicians to choose the best patient care by permitting code level selection based on medical decision-making (MDM) or total time.
  • Promoting payer consistency with more detail added to CPT code descriptors and guidelines.

The AMA has developed an extensive online resource library that includes a checklist, videos, modules, guidebooks, as well as other tools and resources to help transition to the revised E/M office visit codes and guidelines. The revised E/M office visit codes are among 329 editorial changes in the 2021 CPT code set, including 206 new codes, 54 deletions, 69 revisions. The CPT code set continues to see growth in new and novel areas of medicine, with the majority (63 percent) of new codes this year involving new technology services described in Category III CPT codes and the continued expansion of the Proprietary Laboratory Analyses (PLA) section of the CPT code set.

Changes to the CPT code set are considered through an open editorial process managed by the CPT Editorial Panel, an independent body convened by the AMA that collects broad input from the health care community and beyond to ensure CPT content reflects the coding demands of digital health, precision medicine, augmented intelligence, and other aspects of a modern health care system. This rigorous editorial process keeps the CPT code set current with contemporary medical science and technology, so it can fulfill its vital role as the trusted language of medicine today and the code to its future.

Among this year’s important additions to the CPT code set are new medical testing services sparked by the public health response to the COVID-19 pandemic. The CPT code set has been modified with several code additions and revisions that have been approved for immediate use and published for the 2021 CPT code set.

The CPT code set continues to be modified to respond to the fast pace innovation among digital medicine services that can improve access to health care and improved health outcomes for patients across the country. This is illustrated by new codes for retinal imaging and external extended electrocardiogram (ECG) monitoring.

The addition of code 92229 for retinal imaging with automated point-of-care, and revision of codes 92227 and 92228, better support the screening of patients for diabetic retinopathy and increase early detection and incorporation of findings into diabetes care. Innovative solutions like the augmented intelligence technology described by new code 92229 have the potential to improve access for at-risk patient populations by bringing retinal imaging capabilities into the primary care setting.

Technological advances in the field of continuous cardiac monitoring and detection have prompted the addition of codes 93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248, along with associated guideline revisions. These codes will replace Category III codes 0295T, 0296T, 0297T and 0298T, which were deleted. These new codes utilize an innovative algorithmic technology that works in concert with a patch that is much easier to wear for patients and provides more accurate and complete data for physician interpretation.

To assist the healthcare system in an orderly annual transition to a newly modified CPT code set, the AMA will release each new edition four months ahead of the January 1 operational date and develop an insider’s view with detailed information on the new code changes.

Tax situation for Seniors with Medicare Advantage

Tax situation for Seniors with Medicare Advantage

What is a Medicare Advantage plan?

If you are under the original Medicare (Part A and Part B), you might have an option to get your Medicare coverage in another way through a Medicare Advantage plan, offered by Medicare-approved private companies. Medicare Advantage plans must cover everything federal Medicare covers except for Hospice care which is still covered by original Medicare Part A. Some MA plans may offer some extra benefits, such as routine vision care, routine dental care, and prescription drug coverage. With Medicare Advantage insurance you must pay your part B premium.

How much are my Medicare Advantage premiums?

If you do have a Medicare Advantage plan, you most likely are paying two premiums: Your Medicare Part B premium and an additional premium charged by the private insurance company that administers your plan. The MA premium amount will vary from plan to plan. Some MA plans offer a zero monthly premium, but most likely you won’t be able to get out of paying your Part B premium. The standard Part B premium for 2018 is $134 monthly roughly.

What is a tax deduction?

If you meet the criteria set by the Internal Revenue Service you may be eligible get a tax deduction and your premiums paid for Medicare Advantage plans. The IRS states you can subtract your tax deductions from your income before calculating the amount of tax you owe. The more deductions you have, the less you might owe in taxes. For more frequently asked questions when it comes to healthcare, please view our FAQ page.

How can I get a tax deduction for my Medicare Advantage premiums?

When you are filing your taxes with the IRS, you have a choice to take the standard deduction or itemize your tax deductions. To get a tax break or deduction for your Medicare Advantage premium or Medicare Part B premium, you must itemize your tax deductions. The Internal Revenue states that you can deduct certain medical and dental expenses for yourself if you itemize deductions on schedule a form 1040. The IRS has a long list of what is accepted and not excepted items under the category of medical and dental expenses. The one piece you might be able to include is medical and hospital insurance premiums, which might consist of your MA premiums.

There are income limitations on itemizing tax deduction. According to the Internal Revenue services website, you may not be able to deduct all your itemized deductions if your adjusted gross income is more than a certain amount. Check with the Internal Revenue Service or talk to a tax preparer for details.

This article should not be relied on for tax advice, and please consult a tax advisor who understands your particular circumstances to see what, if any, part of your medical expenses may be tax deductible.