In November 2019, the Centers for Medicare & Medicaid Services (CMS) published a final rule that provided changes to the Medicare Physician Fee Schedule (MPFS) effective January 1, 2020. While few pediatric patients are covered by Medicare, Medicaid and other health plans may choose to adopt the Medicare changes.

One set of codes adopted in the final rule might be important to pediatricians who are caring for children with complex medical conditions. Check for information from contracted health plans on coverage of the following Healthcare Common Procedure Coding System codes.

In the MPFS final rule, it was noted that a gap existed in coding and payment for care management services. Specifically, no codes existed for care management for patients with a single high-risk disease or only one complex chronic condition. Current Procedural Terminology (CPT®) codes for chronic care management services (99487 and 9948999491)...

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