Q: In the 2021 OPPS proposed rule, CMS suggested that there is no longer a need for the inpatient-only list. What could this mean for case managers going forward?
CMS continues to focus on site-neutral payment policies and keeping payments down for 340B-acquired drugs in the 2021 OPPS proposed rule, released in early August.
Is the inpatient-only list soon to be a thing of the past? It’s possible. In the 2021 OPPS proposed rule, released August 3, CMS suggested that there is no longer a need for the inpatient-only list. Instead, CMS recommended deferring to the physician’s clinical judgment.
Q: Can modifier -59 (distinct procedural service) be used to bypass the NCCI edit that bundles CPT codes 11055 for lesion removal and 11721 for nail debridement?
