CMS issued its 2027 Outpatient Prospective Payment System (OPPS) final rule last week. The document includes several provisions, including updates to OPPS and ambulatory surgical center (ASC) payment rates, the method of controlling unnecessary increases in outpatient services volumes, the inpatient only (IPO) list, and prior authorization for botulinum toxin injection codes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
For many healthcare organizations, a paid claim feels like a finished claim. The codes were assigned, edits cleared, the claim was submitted successfully, and reimbursement was received. By traditional measures, the process looks successful. But if that claim is audited 18 months later, the question changes from whether it could be billed to whether it can be defended.
A new definition for prescription drug management in the 2027 CPT manual is designed to clear up confusion and set expectations. The 2027 manual adds the definition to the Risk of Complications and/or Morbidity or Mortality of Patient Management (Risk) category for level-based evaluation and management (E/M) codes.
CMS released the 2027 Medicare Physician Fee Schedule (MPFS) final rule, which includes updates related to evaluation and management (E/M) complexity coding, E/M visits during global periods, and remote monitoring.
