For the 2020 performance period, CMS is using the Extreme and Uncontrollable Circumstances policy to allow clinicians, groups, and virtual groups to submit an application requesting reweighting of one or more MIPS performance categories due to the COVID-19 pandemic. As an additional flexibility, CMS has extended the deadline to submit a COVID-19 related 2020 extreme and uncontrollable circumstances application to February 1, 2021.
“In the past, it has been postulated that a doctor had the option of using a fracture code or using E/M codes
to bill for fracture care. With the upcoming changes to E/M reimbursement, it would seem that billing using
E/M codes might make for sense for fracture care. Are there any thoughts on these changes upcoming for
2021?”
“We have billed CPT 11730 for all 10 nails using the appropriate toe modifiers. Anthem Blue Cross paid for five of the toes but is denying the other five. The denial comes back with CO-222 (Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific.) Please advise.”
