Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) – October 2020 Update

Payment files were issued to MACs based on the Calendar Year (CY) 2020 MPFS Final Rule, which was published in the Federal Register on November 15, 2019. These are effective for services provided between January 1, 2020, and December 31, 2020.

Below is a summary of changes in the October update to the 2020 MPFSDB. Three codes in the MPFSDB have revised short descriptors:

• G2011 – Effective October 1, 2020, Short Descriptor = Alcohol/sub misuse assess
• J9305 – Effective October 1, 2020, Short Descriptor = Inj. pemetrexed nos 10mg
• 86318 – Effective April 10, 2020, Short Descriptor = Ia infectious agent antibody
• One new code is effective for dates of service from June 25, 2020, and beyond. Medicare implemented this code under CR 11736 for the October 2020 HCPCS update.
• 87426 – Procedure Status = X; There are no Relative Value Units (RVUs), payment policy indicators do not apply.

The 21 codes below are new codes effective for dates of service from October 1, 2020, and beyond. These codes were also implemented under CR 11736 for the October 2020 HCPCS update.

Note: For all 21 codes below, there are no RVUs, and payment policy indicators do not apply.

Table 1 – New Codes Effective for Dates of Services from October 1, 2020, and Beyond

Code Procedure Status

G1020 X, G1021 X, G1022 X, G1023 X, J1437 E, J1632 E, J1738 E, J3032 E, J3241 E, J7351 E, J9227 E, J9304 E, Q4249 E, Q4250 E,Q4254 E, Q4255 E, Q9001 I, Q9002 I, Q9003 I, T2047 I, V2524 X

Notes: The MACs will not search their files to retract payment for claims already paid or to retroactively pay claims impacted by these changes. However, MACs will adjust claims brought to their attention.

Source: https://www.cms.gov/files/document/r10288cp.pdf