Tag: physician fee schedule

CMS Finalizes Physician Fee Schedule for 2024

Member News

The Centers for Medicare & Medicaid Services (CMS) released the calendar year 2024 Medicare Physician Fee Schedule final rule Nov. 2, aimed at promoting healthcare equity and expanding access to essential services for Medicare beneficiaries. These policies include several crucial areas, such as behavioral health strategies, caregiver support, oral and dental health services linked to cancer treatments, enhancements to the Medicare Diabetes Prevention Program and assessments of social determinants of health.

Building on the agency’s commitment to health equity, CMS is finalizing coding and payment mechanisms for caregiver training services to ensure that healthcare practitioners are compensated for helping Medicare beneficiaries adhere to treatment plans. These are the first Physician Fee Schedule services to include payment for community health workers to address unmet social needs and enable person-centered planning.

The rule also finalizes payments for risk assessments for social determinants of health to ensure seamless integration into healthcare visits.

Lastly, the CMS Behavioral Health Strategy enhances emotional and mental well-being through behavioral health care. This rule creates a mechanism for marriage and family therapists and mental health counselors, including addiction, alcohol or drug counselors, to enroll in Medicare and bill for services beginning January 1, 2024. It also increases payment for crisis care, substance use disorder treatment, psychotherapy and Health Behavior Assessments and Intervention services.

Members with questions may contact Lauren LaPine at the MHA.

CMS Proposes Rate Cuts in 2023 Medicare Physician Fee Schedule

Member News

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule for physician fee schedule (PFS) payments and other Medicare Part B issues, effective Jan. 1, 2023. The rule proposes to reduce the PFS conversion factor by $1.53 (4.6%) to $33.08 in calendar year (CY) 2023, compared to $34.61 in CY 2022. The proposed rule also includes changes in policies for telehealth, opioid use disorder, dental services, and the Medicare Shared Savings Program (MSSP).

The CMS proposes to:

  • Reduce the conversion factor to $33.08, which reflects a required statutory update of 0% and the expiration of the one-year Congress-approved 3% increase in PFS payments for CY 2022.
  • Delay indefinitely the payment penalty period of the Appropriate Use Criteria. The CMS is unable to forecast when the payment penalty phase will begin again.
  • Expand the list of telehealth category 3 codes and extend coverage through Dec. 31, 2023.
  • Delay for one year (until Jan. 1, 2024) implementation of its policy to define the substantive portion of a split (or shared) visit based on the amount of time spent by the billing practitioner.
  • Make several changes to increase participation in the MSSP, including implementing longer glide paths to downside risk for accountable care organizations (ACOs) and modifying benchmarking methodology to ensure ACOs do not have to compete against their own best performance.
  • Expand behavioral health access by permitting licensed professional counselors, marriage and family therapists, and other types of practitioners to provide services, thereby creating an exception to the direct supervision requirement for “incident to” billing.

Members are encouraged to submit comments to the CMS by Sept. 7. Questions and feedback should be directed to Renée Smiddy at the MHA.