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. Official websites use .govA In light of the current needs among Medicare beneficiaries for improved access to behavioral health services, CMS has considered regulatory revisions that may help to reduce existing barriers and make greater use of the services of behavioral health professionals, such as licensed professional counselors (LPCs) and Licensed Marriage and Family Therapists (LMFTs). MARx Monthly Reports Available. Tribal FQHC Payments Comment Solicitation. We finalized new HCPCS codes, G3002 and G3003, and valuation for chronic pain management and treatment services (CPM) for CY 2023. 7500 Security Boulevard, Baltimore, MD 21244 . The PFS conversion factor reflects the statutory update of 0.00 percent and the adjustment necessary to account for changes in relative value units and expenditures that would result from our proposed policies. However, the actual change from the final CY 2021 conversion factor of $34.89 to the proposed CY 2022 conversion factor of $33.58 is a decrease of $1.31 or 3.89%. CMS is finalizing that providers will be required to report the JW modifier beginning January 1, 2023 and the JZ modifier no later than July 1, 2023 in all outpatient settings. CMS will revisit additional increased applicable percentages through future notice and comment rulemaking. 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. You can decide how often to receive updates. Preventive Vaccine Administration Services. NC Medicaid Division of Health Benefits. CMS also solicited comments on whether there are other drugs with unique circumstances that may warrant an increase in the applicable percentage. In contrast, PFS rates paid to physicians and other billing practitioners in facility settings, such as a hospital outpatient department (HOPD) or an ASC, reflect only the portion of the resources typically incurred by the practitioner in the course of furnishing the service. Sign up to get the latest information about your choice of CMS topics. CMS is proposing to add a required field to teaching hospital records to address this issue. CMS is finalizing a series of changes to the Medicare Ground Ambulance Data Collection System. Based on comments received, CMS is finalizing an increased applicable percentage of 35 percent for this drug. However, we solicited comments on the potential use of the proposed updated MEI cost share weights to calibrate payment rates and update the GPCI under the PFS in the future. In the PFS proposed rule, we are proposing to implement the second phase of this mandate by proposing certain exceptions to the EPCS requirement. lock CMS finalized the proposal to permit audiologists to bill for this direct access (without a physician or practitioner order) once every 12 months per beneficiary. Holiday & training closures. Payment is also made to several types of suppliers for technical services, most often in settings for which no institutional payment is, 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. CMS is engaged in an ongoing review of payment for E/M visit code sets. Overall, the de minimis standard would continue to be applicable in the following scenarios: CMS is proposing to implement section 403 of Division CC of the CAA that authorizes Medicare to make direct payment to PAs for professional services they furnish under Part B beginning January 1, 2022. For CY 2022, in response to numerous stakeholder questions and to promote proper therapy care, CMS is proposing to revise the de minimis standard established to determine whether services are provided in whole or in part by PTAs or OTAs. Specifically, we are requesting comments regarding the nominal specimen collection fees for trained personnel to collect specimens from homebound patients and inpatients (not in a hospital). Geographic adjusters (geographic practice cost index) are also applied to the total RVUs to account for variation in practice costs by geographic area. More specifically CMS is seeking information on: CMS is also seeking stakeholder input on two other issues. https:// Medicare payment for dental services is generally precluded by statute. In addition, we are finalizing a policy to update this fee amount annually by the percent change in the CPI-U. 0
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. As a result of public comments, CMS plans to collect additional information about drugs that may have unique circumstances along with what increased applicable percentages might be appropriate for each circumstance. An official website of the United States government 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. Heres how you know. Catherine Howden, DirectorMedia Inquiries Form The following provisions demonstrate CMSs commitment to addressing health equities in rural and vulnerable populations. SUMMARY: This notice announces a $631.00 calendar year (CY) 2022 application fee for institutional providers that are initially enrolling in the Medicare or Medicaid program or the Children's Health Insurance Program (CHIP); revalidating their Medicare, Medicaid, or CHIP enrollment; or adding a new . The statute provides coverage of MNT services by registered dietitians and nutrition professionals, when referred by a physician (an M.D. CMS is also proposing to extend the start date for compliance actions to January 1, 2023, in response to stakeholder feedback. Payment rates are calculated to include an overall payment update specified by statute. Fri., 12/31/2021 : Jan 6 - Thurs. ACTION: Notice. In instances where the service is not defined in 15-minute increments including: supervised modalities, evaluations/reevaluations, and group therapy. CMS finalized the proposal to annually update the payment amount for vaccine administration services based upon the increase in the MEI, and to adjust for the geographic locality based upon the geographic adjustment factor (GAF) for the PFS locality in which the preventive vaccine is administered. Section 3713 of the CARES Act established Medicare Part B coverage and payment for a COVID-19 vaccine and its administration. Medicare annual statistics - Modified Monash Model locations (2009-10 to 2021-22) 20 February 2023. 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. CMS is implementing the final part of section 53107 of the Bipartisan Budget Act of 2018, which requires CMS, through the use of new modifiers (CQ and CO), to identify and make payment at 85% of the otherwise applicable Part B payment amount for physical therapy and occupational therapy services furnished in whole or in part by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs), for dates of service on and after January 1, 2022. An official website of the United States government The calendar year (CY) 2022 PFS proposed rule is one of . 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. 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. 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. 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. This often leads to disputes, a process by which the covered recipient initiates a conversation with the reporting entity to get more information, creating work for both parties. 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. That is, for services furnished on or after January 1, 2022, the coinsurance amount paid for planned colorectal cancer screening tests that require additional related procedures shall be equal to a specified percent (i.e., 20% for CY2022, 15% for CYs 2023 through 2026, 10% for CYs 2027 through 2029, and zero percent beginning CY 2030) of the lesser of the actual charge for the service or the amount determined under the fee schedule that applies to the test. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. We are also proposing to freeze the quality performance standard for PY 2023, by providing an additional one-year before increasing the quality performance standard ACOs must meet to be eligible to share in savings, and additional revisions to the quality performance standard to encourage ACOs to report all-payer measures. 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. We believe the CPM HCPCS codes will improve payment accuracy for these services, prompt more practitioners to welcome Medicare beneficiaries with chronic pain into their practices, and encourage practitioners already treating Medicare beneficiaries who have chronic pain to spend the time to help them manage their condition within a trusting, supportive, and ongoing care partnership. Split (or shared) visits could be reported for new as well as established patients, and initial and subsequent visits, as well as prolonged services. Claims can continue to be billed with the place of service code that would be used if the telehealth service had been furnished in-person through the later of the end of CY 2023 or end of the year in which the PHE ends. From 1 January 2022, patient access to telehealth services will be supported by continued MBS arrangements. This includes resubmitting corrected claims that . The federal . Specifically, CMS is proposing to revise the de minimis policy to allow a timed service to be billed without the CQ/CO modifier in cases when a PTA/OTA participates in providing care to a patient with a physical therapist or occupational therapist (PT/OT), but the PT/OT meets the Medicare billing requirements for the timed service without the minutes furnished by the PTA/OTA by providing more than the 15-minute midpoint (also known as the 8-minute rule). Payment for Attending Physician Services Furnished by RHCs or FQHCs to Hospice Patients. 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 dates listed under Part D also apply to MA and cost-based plans offering a Part D benefit. Payment for Medical Nutrition Therapy (MNT) Services and Related Services. Updates to the Open Payments Financial Transparency Program. Beginning May 2, 2022 and ending June 2, 2022, registration may be completed by presenters only. First, we are seeking input on our preliminary policy to pay $35 add-on for certain vulnerable beneficiaries when they receive a COVID-19 vaccine at home. New Year's Day Monday, January 3 ; Martin Luther King, Jr. Day Monday, January 17 We are also proposing to modify the threshold for determining whether an ACO is required to increase its repayment mechanism amount during its agreement period. Specifically, we are finalizing revisions to 414.507(d) to indicate that for CY 2022, payment may not be reduced by more than 0% as compared to the amount established for CY 2021, and for CYs 2023 through 2025, payment may not be reduced by more than 15% as compared to the amount established for the preceding year. For drugs with unique circumstances, CMS solicited comment on whether an increased applicable percentage would be appropriate for drug that is reconstituted with a hydrogel and administered via ureteral catheter or nephrostomy tube into the kidneys; in this circumstance, there is substantial amount of reconstituted hydrogel that adheres to the vial wall during preparation and not able to be extracted from the vial for administration. Catherine Howden, DirectorMedia Inquiries Form 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. CMS is proposing to allow OTPs to furnish counseling and therapy services via audio-only interaction (such as telephone calls) after the conclusion of the COVID-19 PHE in cases where audio/video communication is not available to the beneficiary, including circumstances in which the beneficiary is not capable of or does not consent to the use of devices that permit a two-way audio/video interaction, provided all other applicable requirements are met. However, this process is not available for companies that do not have any records to report. Requiring Manufacturers of Certain Single-Dose Container or Single-Use Package Drugs to Provide Refunds with Respect to Discarded Amounts. The pandemic has highlighted the importance of access to COVID-19 vaccines, as well as access to other preventive vaccines. The continued arrangements build on the temporary telehealth items introduced as part of the Government's response to the COVID-19 pandemic, and will continue to enable all Medicare eligible Australians to access telehealth (video and phone) services for a range of (out of hospital . These destinations include, but are not limited to, any location that is an alternative site determined to be part of a hospital, critical access hospital(CAH)or skilled nursing facility (SNF), community mental health centers, Federally qualified health centers, rural health clinics, physician offices, urgent care facilities, ambulatory surgical centers, any location furnishing dialysis services outside of an end-stage renal disease (ESRD) facility when an ESRD facility is not available, and the beneficiarys home. Only payments that are associated with research should be delayed for publication. CMS is proposing several provider enrollment regulatory revisions that will strengthen program integrity while assisting Medicare beneficiaries. As part of the ongoing updates to E/M visit codes and related coding guidelines that are intended to reduce administrative burden, the AMA CPT Editorial Panel approved revised coding and updated guidelines for Other E/M visits, effective January 1, 2023. Medicare Advantage Rates & Statistics. The proposals to implement section 90004 of the Infrastructure Act included: how discarded amounts of drugs are determined; a definition of which drugs are subject to refunds (and exclusions); when and how often CMS will notify manufacturers of refunds; when and how often payment of refunds from manufacturers to CMS is required; refund calculation methodology (including applicable percentages); a dispute resolution process; and enforcement provisions.