In 2020, there are changes to some of the existing CPT codes, new codes were added and some were deleted. As a healthcare provider, you should have an idea of what these changes are to ensure that you utilize the correct codes and get reimbursed for all the services performed. Summarized below are the changes in CPT that took place effective January 1st of 2020.

New Online Digital Evaluation and Management Services

There are new CPT codes added to represent the Online Digital Evaluation and Management services for established patients.

• 99421 – Online digital evaluation and management service, for an established patient, for up to seven (7) days, a cumulative time during the seven (7) days; 5-10 minutes

• 99422 – …11-20 minutes

• 99423 – …21 or more minutes

These include codes for the new services that represent patient-initiated communication via HIPAA compliant platforms (EHR or secure email). These codes shouldn’t be used for new patients or established patients with new problems.

These codes are time-based, meaning that they represent a cumulative time of a 7-day period. If the Online Digital Evaluation and Management services were performed over multiple days during the 7-day window, then the total time should be combined to report the correct code. If the time is less than 5 minutes, the codes cannot be reported.

Note that codes can only be reported once every seven (7) days. The online digital evaluation and management service includes time spent on the following:

• Review of an initial patient’s inquiry (start of the 7-day period)

• Review of patient record for assessment of the patient’s problem

• Interaction with other healthcare professionals focused on the patient’s problem

• Development of management plans (prescriptions, test orders, etc.)

• Communication with the patient (online, email, etc.)

If the patient contacts the provider about an established problem addressed in the Evaluation and Management service that occurred during the 7-day window, the work would be included in the face-to-face Evaluation and Management service performed during that window. Online digital evaluation and management cannot be used.

Code 99444 has been deleted. This code used to be about the online evaluation and management service provided by a qualified healthcare professionals using the internet or other electronic communications networks.

In the Medicine section, the Qualified non-physician healthcare professional online digital evaluation and management service codes were added as well:

• 98970 - Qualified non-physician health care professional online digital evaluation and management service, for an established patient, for up to seven (7) days, a cumulative time during the seven (7) days; 5-10 minutes

• 98971 - …11-20 minutes

• 98972 - …21 or more minutes

Code 98969 was deleted and replaced with the codes listed above.

Self-Measured Blood Pressure Services

Self-Measured Blood Pressure Services also have new codes added. These are:

• 99473 - Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration

• 99474 - Self-measured blood pressure using a device validated for clinical accuracy; separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient or caregiver to the physician or other qualified health care professional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient

The device used to measure the blood pressure should be validated for clinical accuracy. Code 99473 represents the work related to making sure that the device is calibrated and patient education and training were enforced properly. Note that the code can only be reported once per device.

On the other hand, code 99474 is all about the health provider’s work on reviewing the data received from the patient or caregiver. Providers are required to review at least 12 readings of the data with an accurate report.

Remote Physiologic Monitoring

This particular service was revised, and an additional code was created to represent the additional 20 minutes of clinical staff professional time in a calendar month. Code 99457 represents the remote physiologic monitoring treatment services of a provider in a calendar month for 20 minutes. Meanwhile, the new add-on code 99458 represents the succeeding 20 minutes thereafter.

To report code 99457, a minimum of 20 minutes of service must be rendered. If the total time is 40 minutes, then both codes should be reported. Note that the time spent for other services in remote physiologic monitoring services should not be included.

Dry Needling or Trigger Point Acupuncture

There are new CPT codes for needle insertion without injection. It should be reported based on the number of muscles in which the needles are inserted. For one (1) or two (2) muscles, the code is 20560. For three (3) or more muscles, the code is 20561.

Nervous System: Anesthetic Agents and/or Steroid Nerve Injections

There are a lot of changes and revisions in the code family 64400-64450. Codes 64400, 64405, 64408, 64416, 64417, 64418, 64425, 64430, 64435, 64446, 64448, 64449, and 64450 were revised to indicate “Injection(s) (plural), anesthetic agent(s) and/or steroid” for clarification that multiple injections performed on the same nerve must be reported once and that the substance injected may include steroids.

Another revision was made to CPT codes 64415, 64445, 64447. The codes were revised to remove “single” in the description. Also, in the CPT code 64420 “Injection, anesthetic agent; intercostal nerve, single level,” a “single-level” was added to the description and the code 64421 became an add-on code to 64420, to represent “each additional level”.

Here’s a summary of the new codes added under this code family:

• 64451 - “Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (i.e., fluoroscopy or computed tomography)”

• 64454 - “ Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed”

• 64624 - “ Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed”

• 64625 - “Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (i.e., fluoroscopy or computed tomography)”

Codes 64402 (Injection, anesthetic agent; facial nerve), 64410 (Injection, anesthetic agent; phrenic nerve), and 64413 (Injection, anesthetic agent; cervical plexus) were deleted and not valid for 2020.

Pathology and Laboratory

A new set of codes were added for the qualitative therapeutic testing. These are:

• 80145 - Adalimumab

• 80230 - Infliximab

• 80235 - Lacosamide

• 80187 - Posaconazole

• 80280 - Vedolizumab

• 80285 - Voriconazole

Molecular Pathology Codes

There’s also a new set of codes for molecular pathology this 2020. Here are the new codes to be applied:

• 81277 - Cytogenomic neoplasia (genome-wide) microarray analysis, interrogation of genomic regions for copy number and loss-of-heterozygosity variants for chromosomal abnormalities

• 81307 - PALB2 (partner and localizer of BRCA2) (e.g., breast and pancreatic cancer) gene analysis; full gene sequence

• 81308 - … known familial variant

• 81309 - PIK3CA (phosphatidylinositol- 4, 5-biphosphate 3-kinase, catalytic subunit alpha) (e.g., colorectal and breast cancer) gene analysis, targeted sequence analysis (e.g., exons 7, 9, 20)

New multianalyte assays with algorithmic analyses (MAAA) and Mycoplasma codes

Listed below are the new codes for MAAA and Mycoplasma:

• 81522 - Oncology (breast), mRNA, gene expression profiling by RT-PCR of 12 genes [eight (8) content and four (4) housekeeping], utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence risk score

• 81542 - Oncology (prostate), mRNA, microarray gene expression profiling of 22 content genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a metastasis risk score

• 81552 - Oncology (uveal melanoma), mRNA, gene expression profiling by real-time RT-PCR of 15 genes [12 content and three (3) housekeeping], utilizing fine needle aspirate or formalin-fixed paraffin-embedded tissue, algorithm reported a risk of metastasis

• 87563 - Mycoplasma genitalium, amplified probe technique

Vaccines

There are changes in the codes for the vaccine as well.

The new code for the Influenza virus vaccine is 90694. This is quadrivalent, inactivated, adjuvanted, preservative-free, 0.5 mL dosage for intramuscular use. The Meningococcal vaccine code 90734 was revised and a new one new code added 90619. 90734 now describes “Meningococcal conjugate vaccine, serogroups A, C, W, Y quadrivalent, diphtheria toxoid carrier (MenACWY-D) or CRM197 carrier (MenACWY-CRM), for intramuscular use”. The new code 90619 is for the meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, tetanus toxoid carrier (MenACWY-TT), for intramuscular use.

Biofeedback Training

The 90911 code for biofeedback training was deleted, and two new ones were added:

• 90912 - “Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; initial 15 minutes of one-on-one physician or other qualified health care professional contact with the patient”.

• 90913 - … each additional 15 minutes of one-on-one physician or other qualified health care professional contact with the patient (List separately in addition to code for primary procedure)

Ophthalmology Services

For Ophthalmology services, the codes for retina drawing (92225 and 92226) were deleted and replaced with new codes. Previous codes were based on whether the service provided is initial or subsequent. The new codes are based on the anatomy of the drawing:

• 92201 - Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (e.g., for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral

• 92202 - … with drawing of optic nerve or macula (e.g., for glaucoma, macular pathology, tumor) with interpretation and report, unilateral or bilateral

Computerized Dynamic Posturography

The initial code for this (99458) was revised to describe the procedure more accurately. Now, it will reflect computerized dynamic posturography sensory organization test (CDP-SOT), six (6) conditions (i.e., eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform, and visual sway), including interpretation and report. The new code 92549, reflects the motor control test and adaptation test.

Long-Term EEG Monitoring

For this section, codes 95950, 95951, 95953, 95956 were deleted, and 23 new codes were added (95700-95726). The new codes are time-based and are divided based on the different types of monitoring— unmonitored, intermittent monitoring and maintenance, continuous, real-time monitoring and maintenance. The codes also indicate if the EEG was performed “with” or “without” a video. The codes are also separated for work performed by technical staff and by a physician.