Recent legislation signed by President Trump significantly dampened the 2021 Medicare Part B premium increase that would have occurred, given the estimated growth in Medicare spending next year. The standard monthly premium for Medicare Part B enrollees will be $148.50 in 2021, an increase of $3.90 from $144.60 in 2020. CMS also announced that the annual deductible for Medicare Part B beneficiaries is $203 in 2021, increasing $5 from $198 in 2020. Medicare spending is estimated to grow in 2021. People seeking the care they may have delayed during the COVID-19 public health emergency, availability of more COVID-19 treatments, and availability of COVID-19 vaccines, will increase the need for healthcare in 2021. Currently, there are over 67 million people on Medicare. Medicare is the largest of all the insurance carriers as the baby-boomers continue to age.

Toward the end of each calendar year, all Medicare Administrative Carriers (MAC) have an open enrollment period. The open enrollment period generally is from mid-November through December 31. During this period, providers who are currently enrolled in the Medicare Program can change their current participation status beginning the next calendar year on January 1. The enrollment period is the only time enrolled providers are allowed to change their participation status. These providers should contact their MAC to learn where to send the participation agreement and get the exact dates for the open enrollment period during which the agreement will be accepted. 

New physicians, practitioners, and suppliers can sign the participation agreement anytime and become a Medicare participant at the time of their enrollment into the Medicare Program. The participation agreement will become effective on the date of filing, i.e., the date the participant mails (postmark date) the contract to the carrier or delivers it to the administrator.

If you require assistance with Medicare enrollment, par status updates, or insurance credentialing please contact our credentialing department manager Carol Snyder at 855-854-6332 or email

Opting Out definition and restrictions.

Fraud and Abuse Laws:

Medicare terms defined:


On October 27 of this year, the Centers for Medicare & Medicaid Services (CMS) announced the single payment amounts (SPAs) for the Off-The-Shelf (OTS) Back Braces and OTS Knee Braces product categories included in Round 2021 of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) and began awarding contracts in certain competitive bidding areas (CBAs).

If you do not know if you are located within a competitive bidding area, you may check your location here.

If you are not located within a competitive bidding area, it’s business as usual for at least the coming year…

If you are located within a CBA, certain areas have faced more significant reductions in reimbursement than others, in many localities the reduction for OTS bracing is so small that you may not need to change anything at this time. You may find a complete listing of the allowable fee schedule in your area here.

While CMS postponed the CBP for 13 categories of Home Medical Equipment (HME) due to the COVID-19 global pandemic, unfortunately, back braces and knee braces where not included in the 2021 implementation extension.

So, if you did not submit a bid and you are located within a competitive bidding area that has a significant fee schedule reduction what do you do now?

If you are in a CB area but did not win a bid, you can still bill for single-hinge unloading knee bracing, however the brace must be “custom fit” to the patient and billed using the semi-custom HCPCS code L1843, not the Off-The-Shelf code of L1851.

Not all knee braces are approved by Palmetto GBA, the PDAC-Medicare Contractor for Pricing, Data Analysis and Coding of HCPCS Level II DMEPOS Codes, for the semi-custom HCPCS code of L1843. Thankfully, the IPS OAide-3000™ single hinge unloading knee brace is PDAC approved as BOTH L1851 and L1843, so you may bill this brace to CMS and its contractors as either an OTS or as a semi-custom brace! However, if you do choose to bill the brace as a semi-custom fitment you must have a “fitting note” to document how the brace was customized to the patient, and why it was necessary to do so. To assist you in this process we have created a simple to use DME Fitting Note, complete with illustrated pictures.  This necessary fitting note is complementary with your next IPS OAide 3000 Single Hinge Unloading Knee Brace order! 


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If you need a refresher course on how to apply the OAide-3000™ Single Hinge Unloading Knee Brace to your patients, you may find a helpful instructional video on how to fit the brace below.


Physicians and Nurse Practitioners can now bill for evaluation and management and other services when their notes are completed by a non-physician staff member and only reviewed by them:

“Medical Record Documentation in the CY 2020 PFS final rule, CMS finalized broad modifications to the medical record documentation requirements for physicians and certain NPPs. In this CY 2021 PFS final rule, we are clarifying that physicians and NPPs, including therapists, can review and verify documentation entered into the medical record by members of the medical team for their own services that are paid under the PFS. We are also clarifying that therapy students, and students of other disciplines, working under a physician or practitioner who furnishes and bills directly for their professional services to the Medicare program, may document in the record so long as the documentation is reviewed and verified (signed and dated) by the billing physician, practitioner, or therapist.”

Physical therapy can now be billed remotely without physical interaction with the patient for at least the entire 2021 calendar year:

“Additionally, we are finalizing the creation of a third temporary category of criteria for adding services to the list of Medicare telehealth services. Category 3 describes services added to the Medicare telehealth list during the public health emergency (PHE) for the COVID-19 pandemic (COVID-19 PHE) that will remain on the list through the calendar year in which the PHE ends.  We sought comment on services added on an interim basis to the Medicare telehealth list during the COVID-19 PHE that CMS did not propose to add to the Medicare telehealth list permanently or temporarily on a category 3 basis. Based on those comments we are finalizing the addition of a number of services to the Medicare telehealth list on a category 3 basis.”


2021 Medicare physician fee schedule has good news for family medicine

2021 Medicare Telehealth Services Additions

CMS is finalizing the addition of the following list of services to the Medicare telehealth list on a Category 3 basis:

  • Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT codes 99336-99337)
  • Home Visits, Established Patient (CPT codes 99349-99350)
  • Emergency Department Visits, Levels 1-5 (CPT codes 99281-99285)
  • Nursing facilities discharge day management (CPT codes 99315-99316)
  • Psychological and Neuropsychological Testing (CPT codes 96130-96133; CPT codes 96136-96139)
  • Therapy Services, Physical and Occupational Therapy, All levels (CPT codes 97161-97168; CPT codes 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521-92524, 92507)
  • Hospital discharge day management (CPT codes 99238-99239)
  • Inpatient Neonatal and Pediatric Critical Care, Subsequent (CPT codes 99469, 99472, 99476)
  • Continuing Neonatal Intensive Care Services (CPT codes 99478-99480)
  • Critical Care Services (CPT codes 99291-99292)
  • End-Stage Renal Disease Monthly Capitation Payment codes (CPT codes 90952, 90953, 90956, 90959, 90962)
  • Subsequent Observation and Observation Discharge Day Management (CPT codes 99217; CPT codes 99224-99226)”


2021 Medicare physician fee schedule has good news for family medicine

Should you have any
additional questions or concerns about how to adjust your standard operating procedures to comply with the upcoming changes please feel free to contact us at:

Integrative Practice Solutions
Phone: (855) 854-6332
Fax: (727) 683-9536

About the Author: Lance Liberti is a nationally recognized healthcare consultant and new patient marketing professional with more than a decade of practical experience in the field. His experience spans multiple areas of practice including non-surgical spinal decompression, medically supervised weight loss, aesthetic medicine, and non-operative extremity pain management. The president and CEO of Integrative Practice Solutions, Inc. Mr. Liberti specializes in assisting health and wellness professionals integrate boutique medical services into their practices to offer non-surgical solutions to those suffering from various degenerative musculoskeletal conditions. To learn more about Mr. Liberti’s extensive experience and see examples of his work products view his LinkedIn profile here:

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