Health Information Management

CMS finalizes changes to packaged services and E/M coding for clinic visits

HIM-HIPAA Insider, December 9, 2013

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by Jaclyn Fitzgerald, Associate Editor

CMS finalized changes to packaged services and evaluation and management (E/M) CPT® codes for clinic visits with the much-anticipated November 27 release of the 2014 OPPS final rule. The good news is that CMS did not finalize all of the controversial changes to packaged services and E/M CPT codes. The bad news is that despite a delay in releasing the final rule, most of the changes are still effective January 1, 2014.

CMS initially proposed eliminating the five levels of E/M CPT codes for new patient clinic visits, established patient clinic visits, and Type A ED visits, and HCPCS G-codes for Type B ED visits. In its proposed rule, CMS wanted to replace these codes with three new HCPCS G-codes: one HCPCS code for all clinic visits, one for all Type A ED visits, and one for all Type B ED visits. The final rule is a compromise of sorts. CMS will replace existing E/M CPT codes for new and established patient clinic visits with a single HCPCS G-code, while codes for Type A and B ED visits remain the same.

CMS finalized five of the seven proposed packaged services categories, including:

  • Drugs, biologicals, and radiopharmaceuticals that function as supplies when used in a diagnostic test or procedure
  • Drugs and biologicals that function as supplies or devices when used in a surgical procedure
  • Clinical diagnostic laboratory tests (except molecular pathology) when provided on the same date of service as another service
  • Procedures described by add-on codes
  • Device removal procedures


With the introduction of these categories, the majority of clinical diagnostic laboratory tests will no longer be paid under the Clinical Laboratory Fee Schedule. CMS did not finalize the packaging of ancillary services or diagnostic tests on the bypass list, which means these categories will continue to be payable under OPPS.

Additional information on these and other changes finalized under the 2014 OPPS final rule is available on the HCPro website.

Let HCPro help you understand the 2014 OPPS final rule. Sign up for our 11th annual OPPS program at 1 p.m. (Eastern) Wednesday, December 18, with expert speakers Jugna Shah, MPH, and Valerie A. Rinkle, MPA.



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