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. 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. The Telehealth Originating Site Facility Fee has been updated for CY 2023, which can be found with the list of Medicare Telehealth List of Services at the following website: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes. This provision permits CMS to apply a payment limit calculation methodology (the lesser of methodology) to applicable billing codes, if deemed appropriate. CMS is proposing a longer transition for Accountable Care Organizations (ACOs) reporting electronic clinical quality measure/Merit-based Incentive Payment System clinical quality measure (eCQM/MIPS CQM) all-payer quality measures under the Alternative Payment Model (APM) Performance Pathway (APP), by extending the availability of the CMS Web Interface collection type for two years, through performance year (PY) 2023. hbbd```b``+@$Ln`,r~"YwEO0&y$ v;5H[x lN0 = 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. We are proposing to refine our longstanding policies for split (or shared) E/M visits to better reflect the current practice of medicine, the evolving role of non-physician practitioners (NPPs) as members of the medical team, and to clarify conditions of payment that must be met to bill Medicare for these services. In addition, we are seeking comment on different types of compliance actions, so that we may ensure prescribers electronically prescribe controlled substances covered under Part D without overly burdening them. We are also seeking comment on how to address scenarios where a physician or practitioner of the same specialty/subspecialty in the same group may need to furnish a mental health service due to unavailability of the beneficiarys regular practitioner. The 2022 Medicare Physician Fee Schedule is now available in Excel format. lock In addition, we are finalizing a policy to update this fee amount annually by the percent change in the CPI-U. https:// Physicians services paid under the PFS are furnished in various settings, including physician offices, hospitals, ambulatory surgical centers (ASCs), skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities. The proposed methodology allows for the use of data that are more reflective of current market conditions of physician ownership practices, rather than only reflecting costs for self-employed physicians, and also would allow for the MEI to be updated on a more regular basis since the proposed data sources are updated and published on a regular basis. Program of All-Inclusive Care for the Elderly (PACE) Regional Preferred Provider Organizations (RPPO) Special Needs Plans. 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. 100-04, chapter 16, 60.1., did not have corresponding regulations text and some of the manual guidance is no longer applicable. We finalized our proposal to extend the duration of time that services are temporarily included on the telehealth services list during the PHE for at least a period of 151 days following the end of the PHE, in alignment with the Consolidated Appropriations Act, 2022 (CAA, 2022). 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. Further, section 1814(i)(6) of the Act, as added by section 3132(a)(1)(B) of the PPACA, authorized . CY 2022 PFS Ratesetting and Conversion Factor. L. 117-9, November 15, 2021) amended section 1847A of the Act adding provisions that require manufacturers to provide a refund to CMS for certain discarded amounts from a refundable single-dose container or single-use package drug. We are finalizing the addition of chronic pain management and behavioral health integration services to the RHC and FQHC specific general care management HCPCS code, G0511, which aligns with changes made under the PFS for CY 2023. Files are listed by core based statistical areas (CBSAs . For calendar quarters beginning January 1, 2022, the CAA requires manufacturers of drugs or biologicals payable under Part B without a Medicaid Drug Rebate Agreement to report ASP data. CMS is proposing to implement Section 122 of the CAA, which amends the statute by providing a special coinsurance rule for procedures that are planned as colorectal cancer screening tests but become diagnostic tests when the practitioner identifies the need for additional services (e.g., removal of polyps). Read More JK and J6 Medicare Part B Ask-the-Contractor Teleconference means youve safely connected to the .gov website. 2022 Holiday Schedule (for 835 and 837 transactions) . Please feel welcome to reach out to our team if you have any questions. 596 0 obj <> endobj 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). Share sensitive information only on official, secure websites. In December 2020, CMS implemented the first phase of this mandate by naming the standard that prescribers must use for EPCS transmissions and delaying compliance actions until January 1, 2022. 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. 625 0 obj <>stream Last Updated Mon, 15 Nov . Holidays 11 Last day of Quarter Early Release Days Makeup Days: 1. For CY 2023, we are finalizing a number of policies related to Medicare telehealth services, including making several services that are temporarily available as telehealth services for the PHE available at least through CY 2023 in order to allow additional time for the collection of data that may support their inclusion as permanent additions to the Medicare Telehealth Services List. 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. Therefore, CMS is finalizing the proposal to add an exception to the direct supervision requirement under our incident to regulation at 42 CFR 410.26 to allow behavioral health services to be provided under the general supervision of a physician or non-physician practitioner (NPP), rather than under direct supervision, when these services or supplies are furnished by auxiliary personnel, such as LPCs and LMFTs, incident to the services of a physician (or NPP). Secure .gov websites use HTTPSA Customer Support will be closed from 9:30 am - 12 pm CT on the second and fourth . This flexible effective date is intended to take into account the impact that the PHE for COVID-19 has had and may continue to have on practitioners, providers and beneficiaries. Medicare payment for dental services is generally precluded by statute. You can decide how often to receive updates. Payment for Medical Nutrition Therapy (MNT) Services and Related Services. CMS is finalizing a series of changes to the Medicare Ground Ambulance Data Collection System. Vaccine Administration Services Comment Solicitation. Sign up to get the latest information about your choice of CMS topics. 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. Beginning January 1, 2022, PAs would be able to bill Medicare directly for their services and reassign payment for their services. Payment is also made to several types of suppliers for technical services, most often in settings for which no institutional payment is made. 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. Tribal FQHC Payments Comment Solicitation. In instances where the service is not defined in 15-minute increments including: supervised modalities, evaluations/reevaluations, and group therapy. Jan 6 - Thurs. 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. MARx Monthly Reports Available. Spending time (more than half of the total time spent by the practitioner who bills the visit). Over the course of the program, CMS has heard from stakeholders that there is often not enough information included in teaching hospital records for verification that the record was correctly reported. These proposals would result in lower required initial repayment mechanism amounts, and less frequent repayment mechanism amount increases during an ACOs agreement period, thereby lowering potential barriers for ACOs participation in two-sided models and increasing available resources for investment in care coordination and quality improve activities. Chronic Pain Management and Treatment Services. 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. For more details on Shared Savings Program quality proposals, please refer to the Quality Payment Program PFS proposed rule fact sheet:https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1517/2022%20QPP%20Proposed%20Rule%20Overview%20Fact%20Sheet.pdf. 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. As future dates for 2022 are announced, we will update the calendar. website belongs to an official government organization in the United States. Secure .gov websites use HTTPSA Therefore, CMS is finalizing the proposal to add an exception to the direct supervision requirement under our incident to regulation at 42 CFR 410.26 to allow behavioral health services to be provided under the general supervision of a physician or non-physician practitioner (NPP), rather than under direct supervision, when these services or supplies are furnished by auxiliary personnel, such as LPCs and LMFTs, incident to the services of a physician (or NPP). Medicare Cost Plans. ( lock The statute provides coverage of MNT services that may only be provided by registered dietitians and nutrition professionals when referred by a physician (an M.D. See the below for the following updates: Updated Pricing for codes G0339, G0340, 0275T, 0598T & 0599T effective January 1, 2022. CMS is proposing to revise the methodology for calculating repayment mechanism amounts for risk-based ACOs to reduce the percentage used in the existing amount by 50%. We are also seeking comment on whether stakeholders believe there are other codes that should be included in this definition to inform future rulemaking. The research payment format allows CMS to verify that the payment is being delayed correctly. 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. 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. Manufacturers without such agreements have the option to voluntarily submit ASP data. 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. We are, however, finalizing that we will issue a preliminary report on estimated discarded drug amounts based on claims from the first two calendar quarters of 2023 no later than December 31, 2023 and will revisit the timing of the first report in future rulemaking. The dates listed under Part C include MA and MA-PD plans. The full ASC fee schedule is loaded for January and updates made throughout the year are linked for April, July, and October in the table below. Medicare claims must be filed to the MAC no later than 12 months, or 1 calendar year, from the date the services were furnished. More specifically CMS is seeking information on: The different types of health care providers who furnish vaccines and how have those providers changed since the start of the pandemic. Medicare Ground Ambulance Data Collection System. An official website of the United States government. Heres how you know. This calendar schedule will assist in determining the 60th day from the start of care (SOC) date. Medicare currently can only make payment to the employer or independent contractor of a PA. Consequently, PAs could not bill and be paid by the Medicare program directly for their professional services; they also did not have the option to reassign payment for their services or to incorporate with other PAs to bill the program for PA services. ; 2023 We are also proposing to extend the compliance deadline for Part D prescriptions written for beneficiaries in long-term care facilities to January 1, 2025. 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. 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. 7500 Security Boulevard, Baltimore, MD 21244 . website belongs to an official government organization in the United States. Since 1992, Medicare payment has been made under the PFS for the services of physicians and other billing professionals. Holidays: Closed all day, unless otherwise noted. However, this process is not available for companies that do not have any records to report. 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. lock Official websites use .govA CMS proposed to clarify and codify certain aspects of the current Medicare fee-for-services payment policies for dental services. Concurrent Billing for Chronic Care Management Services (CCM) and Transitional Care Management (TCM) Services for RHCs and FQHCs. CMS is proposing to make conforming technical changes to the regulatory text related to COVID-19 vaccines for RHCs and FQHCs. On July 13, 2021, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2022. Share sensitive information only on official, secure websites. For most services furnished in a physicians office, Medicare makes payment to physicians and other professionals at a single rate based on the full range of resources involved in furnishing the service. On November 2, 2021, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates on policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2022. ) Physician-owned distributorships (PODs) are a subset of group purchasing organizations, but are not specifically defined in the Open Payments regulation. 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). The calendar is available in the Downloads section in both a color and plain text format and identifies the following dates: Sign up to get the latest information about your choice of CMS topics. New Year's Day Monday, January 3 ; Martin Luther King, Jr. Day Monday, January 17 Changes to Beneficiary Coinsurance for Additional Procedures Furnished During the Same Clinical Encounter as a Colorectal Cancer Screening. 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. We finalized the clarification that a 12-consecutive month cost report should be used to establish a specified provider-based RHCs payment limit per visit. CMSs proposal would eliminate the confusion that the two types of ownership records may create and facilitate easier understanding and analysis of the data by having only one type of ownership record. There is an exception for payment under the FQHC PPS for certain tribal FQHCs in operation on or before April 7, 2000. When the PTA/OTA furnishes eight minutes or more of the final unit of a billing scenario in which the PT/OT furnishes less than eight minutes of the same service. Catherine Howden, DirectorMedia Inquiries Form 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. An official website of the United States government Start Preamble AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. We grouped these changes and clarifications into four broad categories: editorial changes for clarity and consistency; updates to reflect the web-based system; clarifications responding to feedback from questions from interested parties and testing; and typos and technical corrections. Official websites use .govA Type: Webinar/Teleconference. The federal . To use American Medical Association (AMA) Current Procedural Terminology (CPT) prefatory language as the definition of critical care visits, including bundled services. 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. For more details on Shared Savings Program quality proposals, please refer to the Quality Payment Program PFS proposed rule fact sheet: proposing to revise the methodology for calculating repayment mechanism amounts for risk-based ACOs to reduce the percentage used in the existing amount by 50%. 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. 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