CMS is proposing to add a required field to teaching hospital records to address this issue. We are also seeking comment on whether stakeholders believe there are other codes that should be included in this definition to inform future rulemaking. For a fact sheet on the CY 2023 Quality Payment Program changes, please visit (clicking link downloads zip file): https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2136/2023%20Quality%20Payment%20Program%20Final%20Rule%20Resources.zip, For a fact sheet on the Medicare Shared Savings Program changes, please visit:https://www.cms.gov/files/document/mssp-fact-sheet-cy-2023-pfs-final-rule.pdf, CMS News and Media Group In order to stabilize the price for methadone. When both the PTA/OTA and the PT/OT each furnish less than eight minutes for the final 15-minute unit of a billing scenario. lock The CAA, 2022, also delays the in-person visit requirements for mental health services furnished via telehealth until 152 days after the end of the PHE. CMS is proposing to make regulatory changes to implement the new reporting requirements. the federal holiday schedule tables in the ViPS Medicare System (VMS) on an annual basis. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Washington's Birthday: Monday, Feb. 20. Definition of split (or shared) E/M visits as evaluation and management (E/M) visits provided in the facility setting by a physician and an NPP in the same group. On November 01, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates and policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2023. However, this process is not available for companies that do not have any records to report. Official websites use .govA Lastly, section 130 of the CAA subjects all newly enrolled RHCs (as of January 1, 2021, and after), both independent and provider-based, to a national payment limit per-visit. We are also proposing to allow a one-time opportunity for certain ACOs that established a repayment mechanism to support their participation in a two-sided model beginning on July 1, 2019; January 1, 2020; or January 1, 2021; to elect to decrease the amount of their existing repayment mechanisms. The finalized policy will use a new modifier instead of using a new HCPCS G-code as we proposed because we were persuaded by the commenters that a modifier would allow for better accuracy of reporting and reduce burden for audiologist. Since 1992, Medicare payment has been made under the PFS for the services of physicians and other billing professionals. This calendar schedule will assist in determining the 60th day from the start of care (SOC) date. or We are also finalizing payment for dental exams and necessary treatments prior to the treatment for head and neck cancers starting in CY 2024, and finalizing a process in CY 2023 to review and consider public recommendations for Medicare payment for dental service in other potentially analogous clinical scenarios. Under our existing regulations, if a resident participates in a service furnished in a teaching setting, a teaching physician can bill for the service only if they are present for the key or critical portion of the service. CMS is finalizing requirements for the use of the JW modifier, for reporting discarded amounts of drugs, and the JZ modifier, for attesting that there were no discarded amounts. lock Federal government websites often end in .gov or .mil. With the budget neutrality adjustments, which are required by law to ensure payment rates for individual services dont result in changes to estimated Medicare spending, the required statutory update to the conversion factor for CY 2023 of 0%, and the expiration of the 3% supplemental increase to PFS payments for CY 2022, the final CY 2023 PFS conversion factor is $33.06, a decrease of $1.55 to the CY 2022 PFS conversion factor of $34.61. ; 2023 Files are listed by core based statistical areas (CBSAs . Effective for CY 2023, CMS 1) finalized our proposal to clarify and codify certain aspects of the current Medicare FFS payment policies for dental services when that service is an integral part of specific treatment of a beneficiary's primary medical condition, and 2) other clinical scenarios under which Medicare Part A and Part B payment can be made for dental services, such as dental exams and necessary treatments prior to, or contemporaneously with, organ transplants, cardiac valve replacements, and valvuloplasty procedures. In addition, we are finalizing conforming changes to our requirements for the phase-in of payment reductions to reflect the amendments in section 4(b) of this law. Medically reasonable and necessary tests ordered by a physician or other practitioner and personally provided by audiologists will not be affected by the direct access policy, including the modifier and frequency limitation. Considering the increased needs for mental health services and feedback we have received, we are finalizing our proposal to create a new General BHI code describing a service personally performed by CPs or clinical social workers (CSWs) to account for monthly care integration where the mental health services furnished by a CP or CSW are serving as the focal point of care integration. Share sensitive information only on official, secure websites. In addition, we have been asked to consider certain flexibilities regarding the cost reporting requirement for these types of facilities. CMS is also finalizing the proposal to allow the OTP intake add-on code to be furnished via two-way audio-video communications technology when billed for the initiation of treatment with buprenorphine, to the extent that the use of audio-video telecommunications technology to initiate treatment with buprenorphine is authorized by the Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA) at the time the service is furnished. Before sharing sensitive information, make sure youre on a federal government site. Split (or shared) visits could be reported for new as well as established patients, and initial and subsequent visits, as well as prolonged services. In the CY 2022 PFS proposed rule, we are proposing the following: Similarly, we are proposing to refine our longstanding policies for critical care services. We will take into account the comments we received in response to CY 2023 rulemaking and feedback received in association with the Town Hall in order to strengthen proposed policies for skin substitutes in future rulemaking. CMS is proposing to reduce burden and streamline the Shared Savings Program application process by modifying the prior participation disclosure requirement, so that the disclosure is required only at the request of CMS during the application process, and by reducing the frequency and circumstances under which ACOs submit sample ACO participant agreements and executed ACO participant agreements to CMS. CMS is also finalizing the proposal to permit the use of audio-only communication technology to initiate treatment with buprenorphine in cases where audio-video technology is not available to the beneficiary, and all other applicable requirements are met. On July 13, 2021, the Centers for Medicare and Medicaid Services (CMS) released an advance copy of the calendar year (CY) 2022 Medicare Physician Fee Schedule (PFS) proposed payment rule.The proposed CY 2022 PFS conversion factor is $33.58, a decrease of $1.31 from the CY 2021 PFS conversion factor of $34.89. or D.O.) CMS also proposed and sought comment on payment for other dental services that were inextricably linked to, and substantially related and integral to, the clinical success of, an otherwise covered medical service, such as dental exams and necessary treatments prior to organ transplants, cardiac valve replacements, and valvuloplasty procedures. Since 1992, Medicare payment has been made under the PFS for the services of physicians and other billing professionals. Similar to the approach we finalized in the CY 2021 PFS final rule for office/outpatient E/M visit coding and documentation, we finalized and adopted most of these AMA CPT changes in coding and documentation for Other E/M visits (which include hospital inpatient, hospital observation, emergency department, nursing facility, home or residence services, and cognitive impairment assessment) effective January 1, 2023. CMS is also clarifying that any service furnished primarily for the diagnosis and treatment of a mental health or substance use disorder can be furnished by auxiliary personnel under the general supervision of a physician or NPP who is authorized to furnish and bill for services provided incident to their own professional services. CMS is proposing to revise the current regulatory language for RHC or FQHC mental health visits to include visits furnished using interactive, real-time telecommunications technology. Payment rates are calculated to include an overall payment update specified by statute. Second, as the market for COVID-19 monoclonal antibody products matures, CMS is also seeking comments on whether we should treat these products the same way we treat other physician-administered drugs and biologicals under Medicare Part B. The CY 2023 Medicare Physician Payment Schedule Final Rule updates payment policies and rates as well as other provisions for services offered on or after Jan. 1, 2023, under the Medicare Physician Payment Schedule. However, we believe it would be beneficial to create system efficiencies related to the reconciliation and invoicing system of the discarded drug refunds and the new inflation rebate programs under the Inflation Reduction Act, and so we are not finalizing the timing of the initial report to manufacturers or date by which the first refund payments are due. Secure .gov websites use HTTPSA Spending time (more than half of the total time spent by the practitioner who bills the visit). You can decide how often to receive updates. Some examples include reconstruction of the jaw following fracture or injury, tooth extractions done in preparation for radiation treatment for cancer involving the jaw, or oral exams preceding kidney transplantation. As a health practitioner you must meet certain requirements to bill for Medicare Benefits Schedule (MBS) items under Medicare or prescribe subsidised medicines. . For a fact sheet on the CY 2023 Quality Payment Program changes, please visit (clicking link downloads zip file): https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2136/2023%20Quality%20Payment%20Program%20Final%20Rule%20Resources.zip. Based on comments received, CMS is finalizing an increased applicable percentage of 35 percent for this drug. CMS is finalizing as proposed the definition of a refundable single-dose container or single-use package drug as a drug or biological for which payment is made under Part B and that is furnished from a single-dose container or single-use package. The purpose of this delay is to keep a record from being publicly available because it contains sensitive information for research and development. The following provisions demonstrate CMSs commitment to addressing health equities in rural and vulnerable populations. Conforming Technical Changes to the In-Person Requirements for Mental Health Visits. The changes proposed for Open Payments in the proposed rule are intended to support the usability and integrity of the data for the public, researchers and CMS. The Division of Ambulatory Services in the CMS Center for Medicare is coordinating the CLFS Annual Public Meeting registration. hb```e@( Lb! In the PFS proposed rule, we are proposing to implement the second phase of this mandate by proposing certain exceptions to the EPCS requirement. You can decide how often to receive updates. How the COVID-19 PHE may have impacted costs, and whether health care providers envision these costs to continue. Share sensitive information only on official, secure websites. We are proposing to expand coverage of outpatient pulmonary rehabilitation services, paid under Medicare Part B, to beneficiaries who were hospitalized with COVID-19 and experience persistent symptoms, including respiratory dysfunction, for at least four weeks after hospitalization. We are also seeking comment on whether stakeholders believe there are other codes that should be included in this definition to inform future rulemaking. Holidays: Closed all day, unless otherwise noted. Part B Drug Payment for Section 505(b)(2) Drugs. Contact Information. The finalized direct access policy will allow beneficiaries to receive care for non-acute hearing assessments that are unrelated to disequilibrium, hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids. Under this proposal, any minutes that the PTA/OTA furnishes in the scenarios described above would not matter for purposes of billing Medicare. Mental Health Services furnished via Telecommunications Technologies for RHCs and FQHCs. We also included a comment solicitation seeking public input as we develop a more consistent, predictable approach to incorporating new data in setting PFS rates. The proposed exceptions would apply: We are proposing that prescribers be able to request a waiver where circumstances beyond the prescribers control prevent the prescriber from being able to electronically prescribe controlled substances covered by Part D. We are proposing to initially enforce compliance by sending compliance letters to prescribers violating the EPCS mandate. Under the primary care exception specifically, only MDM would be used to select the visit level to guard against the possibility of inappropriate coding that reflects residents inefficiencies rather than a measure of the time required to furnish the services. For these limited cases, CMS is proposing to allow one 15-minute unit to be billed with the CQ/CO assistant modifier and one 15-minute unit to be billed without the CQ/CO modifier in billing scenarios where there are two 15-minute units left to bill when the PT/OT and the PTA/OTA each provide between 9 and 14 minutes of the same service. 117-7, requires that, beginning April 1, 2021, independent RHCs and provider-based RHCs in a hospital with 50 or more beds receive an increase in their payment limit per visit over an 8-year period, with a prescribed amount for each year from 2021 through 2028. However, this proposed change would allow RHCs and FQHCs to report and receive payment for mental health visits furnished via real-time telecommunication technology in the same way they currently do when visits take place in-person, including audio-only visits when the beneficiary is not capable of, or does not consent to, the use of video technology. However, Medicare currently pays for dental services in a limited number of circumstances, specifically when that service is an integral part of specific treatment of a beneficiary's primary medical condition. The final CY 2023 MEI update is 3.8 percent based on the most recent historical data available. The AMA provides final rule summary (PDF) of the 2023 Medicare Physician Payment Schedule and Quality Payment Program (QPP). 596 0 obj <> endobj Dec 21 5. 625 0 obj <>stream This fee schedule takes effect January 1, 2022, so make sure your office staff are aware of the new information. 7500 Security Boulevard, Baltimore, MD 21244 . CMS is proposing revisions to the definition of primary care services that are used for purposes of beneficiary assignment. In the CY 2022 PFS proposed rule we are proposing: The AMA CPT office/outpatient E/M visit coding framework that CMS finalized for CY 2021, under which practitioners can select the office/outpatient E/M visit level to bill, was based either on use of the total time personally spent by the reporting practitioner or medical decision making (MDM). For CY 2022, in response to stakeholder concerns about parity with other types of NPPs, we are proposing to establish regulations at 410.72 for their services since they are the only NPP type listed at section 1842(b)(18)(C) of the Act without a regulatory provision in this section of 42 CFR subpart B. The proposed method for determining the 2017-based MEI relies on estimating base year expenses from publicly available data from the U.S. Census Bureau NAICS 6211 Offices of Physicians. This modification in our finalized policy necessitates multiple changes to our claims processing systems, which will take some time to fully operationalize, but audiologists may use modifier AB, along with the finalized list of 36 CPT codes, for dates of service on and after January 1, 2023. 02:30 PM-03:30 PM,Eastern Time. Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 10872 Date: July 2, 2021 . Beginning May 2, 2022 and ending June 2, 2022, registration may be completed by presenters only. Holiday & training closures. In the 2022 CMS Behavioral Health Strategy (https://www.cms.gov/cms-behavioral-health-strategy), CMS included a goal to improve access to, and quality of, mental health care services and included an objective to increase detection, effective management, and/or recovery of mental health conditions through coordination and integration between primary and specialty care providers. In CY 2017 and 2018 PFS rulemaking, CMS received comments that initiating visit services for behavioral health integration (BHI) should include in-depth psychological evaluations delivered by a clinical psychologist (CP), and that CMS should consider allowing professionals who were not eligible to report the approved initiating visit codes to Medicare to serve as a primary hub for BHI services. Heres how you know. You may be eligible for Medicaid if your income is low and you match one of the following descriptions: You think you are pregnant. website belongs to an official government organization in the United States. The calendar year (CY) 2022 PFS proposed rule is one of . For a fact sheet on the Medicare Shared Savings Program changes, please visit: https://www.cms.gov/files/document/mssp-fact-sheet-cy-2023-pfs-final-rule.pdf, CMS Proposes Benefit Expansion for Mobility Devices, Advancing Health Equity for People with Disabilities, CMS Announces Increase in 2023 in Organizations and Beneficiaries Benefiting from Coordinated Care in Accountable Care Relationship, CMS Awards 200 New Medicare-funded Residency Slots to Hospitals Serving Underserved Communities, CMS Responding to Data Breach at Subcontractor, Calendar Year (CY) 2023 Medicare Physician Fee Schedule Final Rule - Medicare Shared Savings Program. CMS is proposing to give companies the option to recertify and attest to the fact that they do not have any records to submit for a reporting year. For CY 2022, we are making several proposals that take into account the recent changes to E/M visit codes, as explained in the AMA CPT Codebook, which took effect January 1, 2021. That no other E/M visit can be billed for the same patient on the same date as a critical care service when the services are furnished by the same practitioner, or by practitioners in the same specialty and same group to account for overlapping resource costs. Section 405 of the CAA requires the Office of Inspector General (OIG) to conduct periodic studies on non-covered, self-administered versions of drugs or biologicals that are included in the calculation of payment under section 1847A of the Social Security Act. As proposed, CMS will base the payment amount for the drug component of HCPCS codes G2067 and G2078 for CY 2023 and subsequent years on the payment amount for methadone in CY 2021 and update this amount annually to account for inflation using the PPI for Pharmaceuticals for Human Use (Prescription). Payment for Attending Physician Services Furnished by RHCs or FQHCs to Hospice Patients. You are legally blind. and also establishes the professional qualifications for these practitioners. Here's the March schedule (PDF) for when you should get your Social Security check and/or SSI money: March 1: March SSI payments. lock CMS is proposing a series of standard technical proposals involving practice expense, including the implementation of the fourth year of the market-based supply and equipment pricing update, changes to the practice expense for many services associated with the proposed update to clinical labor pricing, and standard rate-setting refinements. Per statutory requirements, we are also updating the data that we use to develop the geographic practice cost indices (GPCIs) and malpractice RVUs. Rural Health Clinic (RHC) Payment Limit Per-Visit. Section 405 of the CAA also requires that beginning July 1, 2021, the ASP-based payment limit for billing codes representing Cimzia (certolizumab pegol) and Orencia (abatacept) as identified in a July 2020 OIG report adhere to the lesser of methodology. The pandemic has highlighted the importance of access to COVID-19 vaccines, as well as access to other preventive vaccines. These proposals, in addition to existing policies, provide three years for ACOs to transition to reporting the three eCQM/MIPS CQM all-payer measures under the APP. We are proposing to remove the requirement that the medical nutrition therapy referral be made by the treating physician and update the glomerular filtration rate (GFR) to reflect current medical practice. You can decide how often to receive updates. This alert provides a summary of the Medicare Part D disclosure requirements, including a review of: The employers subject to Medicare Part D . Where the prescriber and dispensing pharmacy are the same entity; issue 100 or fewer controlled substance prescriptions for Part D drugs per calendar year. Finally, we are working to address commenters thoughtful feedback and questions regarding the operational aspects of billing and claims processing for these services. We finalized new HCPCS codes, G3002 and G3003, and valuation for chronic pain management and treatment services (CPM) for CY 2023. Under the exception, grandfathered tribal FQHCs bill as if it were provider-based to an Indian Health Service (IHS) hospital and are paid the Medicare outpatient per visit rate, also referred to as the IHS all-inclusive rate (AIR). Weekends: The customer service department is Closed on Saturday and Sunday. For many diagnostic tests and a limited number of other services under the PFS, separate payment may be made for the professional and technical components of services. Individuals who intend to view and/or listen to the meeting do not need to register. There is just one federal holiday in October: Columbus Day. CMS is proposing to require that OTPs use a service-level modifier for audio-only services billed using the counseling and therapy add-on code and document in the medical record the rationale for a service being furnished using audio-only services, in order to facilitate program integrity activities. Medicare Advantage Rates & Statistics. For CY 2023, we are finalizing, as proposed, two updates to expand our Medicare coverage policies for colorectal cancer screening in order to align with recent United States Preventive Services Task Force and professional society recommendations. Read More JK and J6 Medicare Part B Ask-the-Contractor Teleconference Medigap (Medicare Supplement Health Insurance) Medical Savings Account (MSA) Private Fee-for-Service Plans. Last Updated Mon, 15 Nov . We also finalized creation of Medicare-specific coding for payment of Other E/M prolonged services, similar to what CMS adopted in CY 2021 for payment of Office/Outpatient prolonged services. Payment rates are calculated to include an overall payment update specified by statute. Currently, the payment penalty phase of the AUC program is set to begin January 1, 2022. This is because the policies implementing the statutory requirements under section 1833(h)(3)(A) of the Act for the laboratory specimen collection fee, which are currently described in the Medicare Claims Processing Manual Pub. For prescribers who are in the geographic area of a natural disaster, or who are granted a waiver based on extraordinary circumstances, such as an influx of patients due to a pandemic. Federal government websites often end in .gov or .mil. We are also finalizing our proposals to codify and clarify various laboratory specimen collection fee policies in 414.523(a)(1). Start Preamble AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. endstream endobj startxref Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). We confirmed our intention to implement the telehealth provisions in sections 301 through 305 of the CAA, 2022, via program instruction or other subregulatory guidance to ensure a smooth transition after the end of the PHE. identified in a July 2020 OIG report adhere to the lesser of methodology. ( Thus, beginning CY 2022, the coinsurance required of Medicare beneficiaries for planned colorectal cancer screening tests that result in additional procedures furnished in the same clinical encounter will be gradually reduced, and beginning January 1, 2030, will be zero percent. An official website of the United States government People with Medicare, family members, and caregivers should visitMedicare.gov, the Official U.S. Government Site for People with Medicare, for the latest information on Medicare enrollment, benefits, and other helpful tools. Specifically, we are proposing a number of refinements to our current policies for split (or shared) E/M visits, critical care services, and services furnished by teaching physicians involving residents. Beginning January 1, 2022, PAs would be able to bill Medicare directly for their services and reassign payment for their services. Section 3713 of the CARES Act established Medicare Part B coverage and payment for a COVID-19 vaccine and its administration. Additionally, CMS is clarifying that OTPs can bill Medicare for medically reasonable and necessary services furnished via mobile units in accordance with SAMHSA and DEA guidance. The calendar is available in the Downloads section in both a color and plain text format and identifies the following dates: CMS Holidays.