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Key Highlights from the Proposed Medicare Physician Fee Schedule

Key Highlights from the Proposed Medicare Physician Fee Schedule

Highlights from the Proposed 2023 Medicare Physician Fee Schedule

Last month, the Centers for Medicare & Medicaid Services (CMS) issued the highly anticipated 2023 Medicare Physician Fee Schedule Proposed Rule. This year, the telehealth proposals focused primarily on what services will be covered by the program and what will happen following the end of the public health emergency (PHE).

Although the rule proposed reductions across the board, including a 4.4% reduction of the physician conversion factor (CF), it did include new reimbursement opportunities and updates to the remote monitoring, behavioral health, and chronic pain care management codes. There were also significant proposed changes to Accountable Care Organizations (ACOs), the launch of the Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs), initiatives promoting health equity and updates to telehealth services.

In a recent webinar titled, “Everything You Need to Know About the Proposed Rule,” the law team at Nixon Gwilt reviewed the proposed law and provided a detailed overview of its key takeaways. Below are some of the highlights from the webinar with a focus on remote monitoring, behavioral health, chronic pain care management and telehealth services.

Services Covered by the 2023 Medicare Physician Fee Schedule

Remote Therapeutic Monitoring (RTM)

CMS proposed to update the remote therapeutic monitoring (RTM) codes to include clinical staff to support patient monitoring. Currently, RTM can only be furnished by the ordering provider. However, the new set of G codes allows practices to bill Medicare for RTM services provided under general supervision. To implement this change, CMS proposed to replace RTM codes (CPTs 98980 and 98981) with four new HCPCS G codes.

CMS also proposed a new cognitive behavioral therapy code for the initial setup and supply of a cognitive therapy management device. This code can be used with RTM and CCM codes for patient management. For a deeper dive into the new proposed RTM codes, read Nixon Gwilt’s review of the proposed changes.

Behavioral Health Services

To meet the increasing need for patients with mental health services and to address the shortages of workers in this field, CMS proposed to allow for general supervision of clinical staff for ALL behavioral health services provided on an incident basis. CMS also created a new HCPCS G-code that allows clinical psychologists or clinical social workers to deliver care management services for behavioral health conditions. For more information, refer to this article from Nixon Gwilt about CMS’ behavioral health strategy.

Chronic Pain Management

CMS proposed two new G codes for chronic pain management. Although the new codes do not allow services to be provided “incident to” the billing practitioner, CMS requested comments as to whether they could be provided under “general supervision.” In addition, these codes can be billed concurrently with other care management services (BHI, RPM, CCM).

Remote Physiologic Monitoring

Despite stakeholders pointing out that this requirement is contraindicated for certain conditions, CMS indicated that a connected device must transmit 16 days of readings of patient-generated health data to bill for (CPT Code 99453) and (CPT Code 99454).

Telehealth Services

CMS proposed to extend the availability of Medicare’s temporary telehealth services for 151 days after the end of the public health emergency (“PHE”). However, extending reimbursement for telehealth services provided at a patient’s home beyond the current public health emergency (“PHE”) would require an act of Congress.

CMS proposed to add additional services to the list of telehealth services to remain in effect for 151 days after the expiration of the PHE. They also proposed to discontinue audio-only (“E/M”) services other than mental health care following the end of the PHE and the 151-day extension. The complete list of Medicare telehealth codes will be posted on the CMS website.

Additionally, they proposed to extend other PHE-related waivers and exceptions for the 151-day extension period. These include (1) the temporary expansion in telehealth originating sites to include any site in the US where the beneficiary is located at the time of the telehealth service, including an individual's home; (2) the temporary expansion of eligible practitioners to include audiologists and OT/ST/PT; (3) the temporary telehealth payment policies for RHCs and FQHCs; (4) delay of the in-person requirements for audio-only telemental health services; and (5) the temporary coverage of certain telehealth services provided via audio-only during the PHE. CMS has requested additional comments on what types of services could be provided under direct supervision with virtual availability of the supervising practitioner.

Please note, that this is not an exhaustive list of everything the proposed rule covers, but it does highlight many of the key changes in these areas. The information contained in this article is for general education and knowledge of our readers. It is not designed to be, nor should it be used as legal advice.

Learn More About the 2023 Medicare Physician Fee Schedule

For more information about the 2023 Medicare Physician Fee Schedule, please refer to the CMS fact sheet or review the proposed rule.

Comments on the proposed rule are due by September 6, 2022. You can submit comments online through Regulations.gov or by mail.

• Regular Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1770-P, P.O. Box 8016, Baltimore, MD 21244-8016.

• Express Overnight Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1770-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850

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