The Division of Ambulatory Services in the CMS Center for Medicare is coordinating the CLFS Annual Public Meeting registration. As future dates for 2022 are announced, we will update the calendar. That occurs next on Monday, Feb. 20, when federal agencies observe Washington's Birthday (as the third Monday in February is designated in U.S. law). 7500 Security Boulevard, Baltimore, MD 21244, Calendar Year (CY) 2022 Medicare Physician Fee Schedule Proposed Rule. 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. Section 123 of the CAA removed the geographic restrictions and added the home of the beneficiary as a permissible originating site for telehealth services when used for the purposes of diagnosis, evaluation, or treatment of a mental health disorder, and requires that there be an in-person, non-telehealth service with the physician or practitioner within six months prior to the initial telehealth service, and thereafter, at intervals as specified by the Secretary. This refund applies to refundable single-dose container or single-use package drugs beginning January 1, 2023. We are proposing that the changes would be applicable for determining beneficiary assignment beginning with PY 2022. increased applicable percentage of 35 percent for this drug. Our revised colorectal cancer screening policies directly advance our health equity goals by promoting access for much needed cancer prevention and early detection in rural communities and communities of color that are especially impacted by the incidence of colorectal cancer. Medigap (Medicare Supplement Health Insurance) Medical Savings Account (MSA) Private Fee-for-Service Plans. or D.O.). Fri., 12/31/2021 . website belongs to an official government organization in the United States. We are proposing that the changes would be applicable for determining beneficiary assignment beginning with PY 2022. lock The AMA provides final rule summary (PDF) of the 2023 Medicare Physician Payment Schedule and Quality Payment Program (QPP). endstream endobj startxref %%EOF Specified Provider-Based RHC Payment Limit Per-Visit. 616 0 obj <>/Filter/FlateDecode/ID[<93B9AE44C85DD84DBD2BDB2B6969AAC0>]/Index[596 30]/Info 595 0 R/Length 103/Prev 230955/Root 597 0 R/Size 626/Type/XRef/W[1 3 1]>>stream Since 1992, Medicare payment has been made under the PFS for the services of physicians and other billing professionals. As noted above, the rebased and revised MEI weights were not used in CY 2023 PFS ratesetting. means youve safely connected to the .gov website. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Physicians services paid under the PFS are furnished in a variety of settings, including physician offices, hospitals, ambulatory surgical centers (ASCs), skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries homes. Sign up to get the latest information about your choice of CMS topics. The technical component is frequently billed by suppliers, like independent diagnostic testing facilities and radiation treatment centers, while the professional component is billed by the physician or practitioner. Expanding our authority to deny or revoke a providers or suppliers Medicare enrollment in order to protect the Medicare program and its beneficiaries. CMS also solicited comments on whether there are other drugs with unique circumstances that may warrant an increase in the applicable percentage. 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 . CMS has applied this methodology for these billing codes in the July 2021 ASP Drug Pricing files. Specifically, CMS proposed to change the terminology of skin substitutes to wound care management products, and to treat and pay for these products as incident to supplies under the PFS beginning on January 1, 2024. For CY 2022, in response to numerous stakeholder questions and to promote proper therapy care, CMS is proposing to revise the. This regulatory advisor will summarize some of the key changes, but does not include all provisions. CMS is interested in stakeholder input on what qualifies as the home and how we can balance ensuring program integrity with beneficiary access. ) CMS is proposing several provider enrollment regulatory revisions that will strengthen program integrity while assisting Medicare beneficiaries. 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. 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. Payment rates are calculated to include an overall payment update specified by statute. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Therefore, for CY 2023, as in CY 2022, the substantive portion of a visit is comprised of any of the following elements: As finalized, clinicians who furnish split (or shared) visits will continue to have a choice of history, or physical exam, or medical decision making, or more than half of the total practitioner time spent to define the substantive portion instead of using total time to determine the substantive portion, until CY 2024. Opioid Treatment Program (OTP) Payment Policy. Start Preamble AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. website belongs to an official government organization in the United States. The Centers for Medicare and Medicaid Services (CMS) on July 13 released the proposed 2022 Medicare Physician Fee Schedule, addressing Medicare payment and quality provisions for physicians in the next fiscal year. The fee schedules below are effective for dates of service January 1, 2022, through December 31, 2022. Codifying these proposals and revised policies in new regulations at 42 CFR 415.140. Medicare payment for dental services is generally precluded by statute. This calendar schedule will assist in determining the 60th day from the start of care (SOC) date. 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). You are a child or teenager. Section 130 of the CAA as amended by section 2 of P.L. 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. 100-04, chapter 16, 60.1., did not have corresponding regulations text and some of the manual guidance is no longer applicable. Files are listed by core based statistical areas (CBSAs . ( This will increase overall payments for medication-assisted treatment and other treatments for OUD, recognizing the longer therapy sessions that are usually required. CMS is also proposing to extend the start date for compliance actions to January 1, 2023, in response to stakeholder feedback. Oct 5 3. Under the so-called primary care exception, Medicare makes PFS payment in certain teaching hospital primary care centers for certain services furnished by a resident without the physical presence of a teaching physician. Federal government websites often end in .gov or .mil. The statute provides coverage of MNT services by registered dietitians and nutrition professionals when referred by a physician (an M.D. 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). 574 and as required by PAMA, we will increase this amount by $2 for those specimens collected from a Medicare beneficiary in a SNF or by a laboratory on behalf of an HHA, which will result in a $10.57 specimen collection fee for those beneficiaries . 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. 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. 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. lock CMS is finalizing a series of standard technical proposals involving practice expense, including the implementation of the second year of the clinical labor pricing update. Based on comments received, CMS is finalizing an increased applicable percentage of 35 percent for this drug. You have a disability. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. In the PFS proposed rule, we are proposing to implement the second phase of this mandate by proposing certain exceptions to the EPCS requirement. See the 'Urban Area/State Code' and be sure to select the appropriate CBSA to view fees for your facility. We plan to conduct a Town Hall in early CY 2023 with interested parties to address commenters concerns as well as discuss potential approaches to the methodology for payment of skin substitute products under the PFS. 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. Heres how you know. Since January 1, 2002, registered dietitians and nutrition professionals have been recognized to provide and bill for MNT services, meaning nutritional diagnostic, therapeutic, and counseling services. 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. We are also finalizing our proposals to codify and clarify various laboratory specimen collection fee policies in 414.523(a)(1). CMS is finalizing the proposal that locality adjustments for services furnished via mobile units would be applied as if the service were furnished at the physical location of the OTP registered with DEA and certified by SAMHSA. Concurrent Billing for Chronic Care Management Services (CCM) and Transitional Care Management (TCM) Services for RHCs and FQHCs. An official website of the United States government 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. Payments are based on the relative resources typically used to furnish the service. Customer Support will be closed from 9:30 am - 12 pm CT on the second and fourth . We finalized new HCPCS codes, G3002 and G3003, and valuation for chronic pain management and treatment services (CPM) for CY 2023. https://www.federalregister.gov/public-inspection/current, https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1517/2022%20QPP%20Proposed%20Rule%20Overview%20Fact%20Sheet.pdf, Federally-facilitated Exchange Improper Payment Rate Less Than 1% in Initial Data Release, Fiscal Year 2022 Improper Payments Fact Sheet, CY 2023 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule with Comment Period (CMS 1772-FC), Fiscal Year 2023 Inpatient Rehabilitation Facility Prospective Payment System Final Rule (CMS-1767-F), Fiscal Year 2023 Medicare Inpatient Psychiatric Facility Prospective Payment System Final Rule (CMS-1769-F). 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. The final CY 2023 MEI update is 3.8 percent based on the most recent historical data available. In order to stabilize the price for methadone for CY 2023 and subsequent years, CMS is finalizing the proposal to revise our methodology for pricing the drug component of the methadone weekly bundle and the add-on code for take-home supplies of methadone. CMS is proposing to make conforming technical changes to the regulatory text related to COVID-19 vaccines for RHCs and FQHCs. ( When implementing this provision, the Centers for Medicare & Medicaid Services (CMS) finalized in the FY 2011 Hospice Wage Index final rule (75 FR 70435) that the 180th day recertification and subsequent recertifications would correspond to the beneficiary's third or subsequent benefit periods. Then, in subsequent years, the limit is updated by the percentage increase in Medicare Economic Index (MEI). Official websites use .govA 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. In this rule, CMS finalized refinements to the payment amount for preventive vaccine administration under the Medicare Part B vaccine benefit, which includes the influenza, pneumococcal, hepatitis B, and COVID-19 vaccine and their administration. This online disclosure is due sixty (60) days after the first day of each plan year, and for calendar year plans it should be made by March 2, 2022 (but see Timing of the Disclosure to CMS Form below). 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. We finalized the proposal to allow physicians and practitioners to continue to bill with the place of service (POS) indicator that would have been reported had the service been furnished in-person. 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. CMS is also announcing that we are making permanent the option for laboratories to maintain electronic logs of miles traveled for the purposes of covering the transportation and personnel expenses for trained personnel to travel to the location of an individual to collect a specimen sample. CMS is proposing revisions to the definition of primary care services that are used for purposes of beneficiary assignment. Columbus Day is on the second Monday of October which falls between October 8th and October 14th. In addition to cases where one remaining unit of a multi-unit therapy service to be billed, this revision to the policy would apply in a limited number of cases where more than one unit of therapy, with a total time of 24-28 minutes is being furnished. How the COVID-19 PHE may have impacted costs, and whether health care providers envision these costs to continue. Second, we are expanding the regulatory definition of colorectal cancer screening tests to include a complete colorectal cancer screening, where a follow-on screening colonoscopy after a Medicare covered non-invasive stool-based colorectal cancer screening test returns a positive result. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Additionally, in light of the distinction between a PHE declared under section 319 of the Public Health Service Act (PHS Act) and an Emergency Use Authorization (EUA) declaration under section 564 of the Food, Drug, and Cosmetic Act (FD&C Act), and the possibility that they will not terminate at precisely the same time, CMS is clarifying the policies finalized in the CY 2022 PFS final rule regarding the administration of COVID-19 vaccine and monoclonal antibody products, to reflect that those policies will continue through the end of the calendar year in which the EUA declaration for drugs and biological products is terminated. It also gives the Secretary authority to enforce non-compliance with the requirement and to specify appropriate penalties for non-compliance through rulemaking. For additional Customer Contact Center closures due to scheduled training exercises, refer to: Scheduled Contact . We observe most federal holidays, as well as select additional corporate holidays. Also, you can decide how often you want to get updates. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 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. Catherine Howden, DirectorMedia Inquiries Form Holidays 11 Last day of Quarter Early Release Days Makeup Days: 1. or At present, the addition of any procedure beyond the planned colorectal screening (for which there is no coinsurance) results in a beneficiarys having to pay coinsurance. Subsequent to the publication of the CY 2022 PFS final rule, which implemented changes to the RHC payment limit as required by the Consolidated Appropriations Act, 2021, interested parties requested clarification regarding the timing of cost reports used to set the RHC payment limit. 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 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. Accordingly, CMS is proposing to include a specific definition for PODs, as well as make explicit the requirement for PODs to report and self-identify. This policy determines which professional should bill for a shared visit by defining the substantive portion, of the service as more than half of the total time. An official website of the United States government Vaccine Administration Services Comment Solicitation. 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. View below dates indicate when Noridian operations, including the Contact Center phone lines, will be unavailable for customer service. CMS's testing guidance, originally issued in 2020 and also revised on September 23, 2022, reiterates that residents who leave the facility for 24 hours or longer should be treated like new admissions. Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). Before sharing sensitive information, make sure youre on a federal government site. At the end of each year, the MAPD Help Desk issues the MARx Monthly Calendar for the coming year. Further, section 1814(i)(6) of the Act, as added by section 3132(a)(1)(B) of the PPACA, authorized . As CMS continues to evaluate the temporary expansion of telehealth services that were added to the telehealth list during the COVID-19 PHE, CMS is proposing to allow certain services added to the Medicare telehealth list to remain on the list to the end of December 31, 2023, so that there is a glide path to evaluate whether the services should be permanently added to the telehealth list following the COVID-19 PHE. 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. lock 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. https:// How the costs of furnishing flu, pneumococcal, and hepatitis B vaccines compare to the costs of furnishing COVID-19 vaccines, and how costs may vary for different types of health care providers.
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