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There are several Current Procedural Terminology (CPT ® ) code changes that urologists should understand that will be effective January 1, 2020, including changes to the orchiopexy code, new codes for biofeedback (with elimination of the old code), a new Category III code Transurethral ablation of malignant prostate tissue by high-energy water vapor thermotherapy with a new parenthetical to CPT 53854, and four new Category III codes for Percutaneous implantation or replacement of integrated single device neurostimulation system including electrode array and receiver or pulse generator. Revision under Urinary System/Bladder/Introduction 51715  Endoscopic ...
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This week’s update includes information on the AUA’s collaboration efforts in recognizing Congressman Andy Harris, MD (R-MD-01) as a champion for senior’s access to healthcare and our meeting with the chief of staff for newly elected urologist Rep. Greg Murphy, MD. Patient Advocacy: AUA Joins Coalition in Recognizing Lawmaker as Champion for Healthy Seniors On October 9, the AUA joined the Partnership to Fight Chronic Disease in presenting the 2019 Champion for Healthy Seniors Award to Rep. Andy Harris, MD (R-MD-01). The award was given to Congressman Harris for his outstanding leadership to protect Medicare Part D and the benefits it provides to seniors, ...
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Merit-based Incentive Payment System (MIPS) participants who are impacted by extreme and uncontrollable circumstances may submit a request for reweighting the Quality, Cost, and Improvement Activities performance categories. “Extreme and uncontrollable circumstances” are defined as rare events entirely outside of one’s control and the control of the facility in which one practices. These extreme and uncontrollable circumstances would either cause the provider to be: Unable to collect information necessary to submit for a performance category, or Unable to submit information that would be used to score a performance category for an extended period ...
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Registration is now open for anyone interested in forming a virtual group for the 2020 Merit-based Incentive Payment System (MIPS) performance year. To form a virtual group, one must follow an election process and submit election materials to CMS via email by December 31, 2019 .  Details about virtual groups and the election process are available via a CMS developed toolkit . What is a Virtual Group? A virtual group is a combination of two or more Taxpayer Identification Numbers (TINs) assigned to: One or more solo practitioners (who are MIPS eligible clinicians); or One or more groups consisting of 10 or fewer clinicians (including at least ...
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The Food and Drug Administration (FDA) announced several supplements promoted for sexual enhancement have been found to contain undeclared active ingredients.  The presence of undeclared active ingredients renders the products unapproved drugs for which safety and efficacy has not been established and, therefore, subject to recall.  The concerned products and the undeclared active ingredient include: Anaconda Strong Formula , sildenafil Green Lumber , tadalafil Lung Leader , sildenafil   Sildenafil and tadalafil are FDA approved drugs for the treatment of male erectile dysfunction. While there are no reports of illness associated with these supplements, ...
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On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) released the CY 2020 Medicare Program; Proposed Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs (CMS-1717-P). The AUA submitted its comment letter on September 24. The letter provided specific comments on the provisions of the rule, including: 2020 Device Pass-Through Payment for AquaBeam® System: The AUA believes the AquaBeam System meets all the necessary criteria and should be awarded Transitional Pass-Through Payment Status effective January 1, 2020. APC Assignment for New CPT Code 55854 Transurethral ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes a revision to the criteria from Independence Blue Cross for the Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia. ConnectiCare has updated the Luteinizing Hormone Releasing Hormone (LHRH) Agonists and Antagonist Pharmacy Policy, Horizon Blue Cross Blue Shield New Jersey updated the Prostatic Urethral Lift medical policy, New Hampshire Healthy Families has updated the Physician’s Consultation Services Payment Policy and Ventegra has updated the Botox, Dysport, Xeomin Pharmacy ...
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This week’s update includes information on the 6 th Annual Bladder Health Alliance Roundtable meeting, the Omnibus Burden Reduction Final Rule, our congressional advocacy regarding topics such as MACRA implementation and Veterans’ Healthcare, and the AUA’s collaboration with state urological societies. AUA Convenes More Than 25 Advocacy Organizations at 6 th Annual Bladder Health Alliance Roundtable Meeting On October 2, the AUA and the Urology Care Foundation hosted a successful Bladder Health Alliance Roundtable meeting that brought together more than 25 patient, physician, and research advocacy organizations. Advocates convened for a full day meeting ...
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Cooperative effort by AUA, other groups results in reasonable timelines and changes to evaluation and management codes In 2018, the Centers for Medicare & Medicaid Services (CMS) released a plan to make sweeping changes to Evaluation & Management (E/M). The proposal elicited a strong response from top medical groups around the country, including the AUA, who opposed the changes. In response to the 2019 proposed rule, the AUA has been actively engaged with the E/M Coalition, the American Medical Association’s CPT/RUC Workgroup on E/M, the Alliance of Specialty Medicine and the Surgical Coalition to develop and share with CMS fair, data-driven recommendations ...
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Top takeaways from Centers for Medicare & Medicaid Services (CMS) October 4th Clinician Outreach meeting focused on the Omnibus Burden Reduction (Conditions of Participation) Final Rule and the transition period to the new Medicare Beneficiary Identifier (MBI). Omnibus Burden Reduction (Conditions of Participation) Final Rule On September 26, 2019, CMS published the Omnibus Burden Reduction (Conditions of Participation) Final Rule, which implements the Trump administration’s directive to “cut the red tape,” by reducing unnecessary burden for American’s healthcare providers allowing them to focus on their priority – patients.  The Omnibus Burden Reduction ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes a revision to the criteria for Sacral Nerve Stimulation from Quartz Health Plan, and Medical Mutual’ s update for the GnRH Antagonists medical policy. Blue Cross of Idaho has updated the Prostatic Urethral Lift medical policy coverage, and Blue Cross Blue Shield of Kansas has revised the Intensity Modulated Radiation Therapy medical policy. See below for further details on all of these updates.  Quartz Health Plan Corporation Sacral Nerve Stimulation: Quartz Health Plan Corporation has reviewed the Sacral Nerve Stimulation medical ...
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For the 2019 reporting year, the Centers for Medicare & Medicaid Services (CMS) made substantial changes to the Promoting Interoperability (PI) category of the Merit-based Incentive Payment System (MIPS). One noticeable change is that there are only two bonus measures, and each is worth 5 points toward your overall PI score.  Depending on your practice, adapting your practice patterns to include either or both measures might be beneficial to your MIPS score and/or your patients and practice. Query of Prescription Drug Monitoring Program (PDMP) Measure This measure requires that at any point during a provider’s 90-day PI reporting period, he/she ...
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This week’s update includes information on the AUA’s comments on several proposed rules, our congressional advocacy supporting access to prostate cancer screening, opposing the medical device tax, and raising awareness for preventive screening at the Veteran’s Health Administration. AUA Submits Comments on 2020 Proposed Fee Schedule, HOPPS/ASC Rules Last week, the AUA submitted to the Centers for Medicare & Medicaid Services our comments on the 2020 proposed rules for the Medicare Physician Fee Schedule (MPFS) (which includes updates to the Quality Payment Program, Open Payments and other Medicare Part B policies) and the Hospital Outpatient / Ambulatory ...
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On September 17, Representatives Devin Nunes (R-CA) and John Larson (D-CT) introduced the Ambulatory Surgical Center Quality and Access Act of 2019 (H.R. 4350) . This important bill would assist in levelling payment for facility fees, collect appropriate quality data, add a representative to the advisory panel on Hospital Outpatient Payment and, most importantly, disclose the reasons why many procedures are denied on the Ambulatory Surgical Center (ASC) list of procedures. This bill would directly impact providers who either own or perform procedures in an ASC, including many AUA members. The AUA has joined the Ambulatory Surgery Center Association ...
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AUA continues efforts to promote prior authorization reform As part of its “Patients over Paperwork” initiative, the Centers for Medicare & Medicaid Services (CMS) released the Omnibus Burden Reduction (Conditions of Participation) Final Rule on September 26. The final rule will create savings and reduce burden in many areas. Several of the changes will create measurable monetary savings for providers and suppliers, while others will create less quantifiable savings of time and administrative burden. CMS anticipates a total first year net savings of approximately $843 million, and slightly more in future years. The rule predominately impacts regulations ...
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On September 17, 2019, the Food and Drug Administration (FDA) approved apalutamide (Erleada, Janssen Biotech, Inc.) for patients with metastatic castration-sensitive prostate cancer (mCSPC). Apalutamide was initially approved in 2018 for patients with non-metastatic castration-resistant prostate cancer. A randomized, double-blind, placebo-controlled, multi-center clinical trial was conducted using 1,052 patients with mCSPC with patients receiving either apalutamide 240 mg daily (four 60 mg tablets; the recommended dose) or a placebo. High- and low-volume disease patients were included in the study. Overall survival (OS) and radiographic progression-free survival ...
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As your practice gears up for another busy year in 2020, it is important to stay current on key coding issues. There are a number of things that your practice can do to prepare for the upcoming year. Update Coding Books: Be sure to order the latest editions of the Current Procedural Terminology (CPT ® ), International Classification of Diseases (ICD) and Healthcare Common Procedural Coding Systems (HCPCS) books. Using outdated books can lead to unnecessary denials or delayed reimbursement. Purchasing new books each year can be costly, but it the return on the investment from accurate coding and timely payment is worth it.  Urologic services span from the ...
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Growth in Medicare spending and indirect medical education (IME) payments were among the topics of discussion at the September 2019 meeting of the Medicare Payment Advisory Commission (MedPAC). MedPAC is an independent Commission whose primary role is to advise Congress on issues affecting the Medicare program. It does so through two reports: its March report on Medicare Payment Policy, and a June report on Medicare and the Health Care Delivery System. MedPAC meets monthly to discuss policy issues and to formulate recommendations for these reports. Medicare Payment Policy: Context The meeting began with a presentation on the “Context for Medicare payment ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes revisions to the Surgical and Minimally Invasive Therapies for the Treatment of Benign Prostatic Hypertrophy medical policy from Geisinger Health Plan, a new pre-service medical necessity determination review for its Molecular and Genomic Testing Program from Horizon BCBS New Jersey, the removal of a Miscellaneous Investigational Procedures code from BCBS Kansas City Missouri, and revisions to its Growth Hormones and Increlex PA Criteria from Massachusetts Medicaid. Please see below for further details on each update. Geisinger Health ...
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On June 27, 2019 the AUA posted a BCG Coding and Billing Update on the AUA’s Policy & Advocacy blog. The new HCPCS code J9030 BCG live intravesical, 1 mg became effective on July 1, 2019 and replaced J9031 BCG (intravesical) per instillation . Medicare made this change to allow more accurate reporting of BCG if a provider uses less than a whole vial of BCG (50 mg) for one patient, as stated in the previous article. Since this article was published, the Coding Hotline has received numerous calls regarding the proper coding for BCG. AUA Coding Education Trainer Edna Maldonado answers the most commonly asked questions below. Frequently Asked Questions ...
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