This approach would be applied to section 505(b)(2) drug products where a billing code descriptor for an existing multiple source code describes the product and other factors, such as the products labeling and uses, are similar to products already assigned to the code. Also, you can decide how often you want to get updates. 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. or That is, the Medicare payment limit for the drug or biological billing code would be the lesser of: (1) the payment limit determined using the current methodology (where the calculation includes the ASPs of the self-administered versions), or (2) the payment limit calculated after excluding the non-covered, self-administered versions. 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. We are proposing to amend the beneficiary notification requirement to set forth different notification obligations for ACOs depending on the assignment methodology selected by the ACO to help avoid unnecessary confusion for beneficiaries. hbbd```b``+@$Ln`,r~"YwEO0&y$ v;5H[x lN0 = 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. In addition, we are finalizing a policy to update this fee amount annually by the percent change in the CPI-U. Epiphany 2022. ( 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. While we implemented this change through our usual change request process, we neglected to update this regulation when the Affordable Care Act (ACA) of 2010 amended the statute to except the coinsurance and deductible for preventive services defined under section 1861(ddd)(3) of the Act that have a grade of A or B from the United States Preventive Services Task Force and MNT services received a grade of B. 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. CMS is proposing to allow RHCs and FQHCs to bill for TCM and other care management services furnished for the same beneficiary during the same service period, provided all requirements for billing each code are met. permanently cover and pay for covered monoclonal antibody products used as pre-exposure prophylaxis for prevention of COVID-19 under the Medicare Part B vaccine benefit. Over the last several years, Medicare payment rates for physicians and mass immunizers for administering certain preventive vaccines (flu, pneumonia and hepatitis B vaccines) have decreased by roughly 30%. 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. This will increase overall payments for medication-assisted treatment and other treatments for OUD, recognizing the longer therapy sessions that are usually required. Mental Health Services furnished via Telecommunications Technologies for RHCs and FQHCs. 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 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. CMS is also proposing changes to address an overlap between general and ownership payments. Manufacturers without such agreements have the option to voluntarily submit ASP data. The superintendent The finalized codes include a bundle of services furnished during a month that we believe to be the starting point for holistic chronic pain care, aligned with similar bundled services in Medicare, such as those furnished to people with suspected dementia or substance use disorders. increased applicable percentage of 35 percent for this drug. Considering the increased needs for mental health services and feedback we have received, we are finalizing our proposal to create a new General BHI code describing a service personally performed by CPs or clinical social workers (CSWs) to account for monthly care integration where the mental health services furnished by a CP or CSW are serving as the focal point of care integration. here are several provisions that CMS is proposing that are aimed at bolstering the abilities of RHCs and FQHCs to furnish care to underserved Medicare beneficiaries. New Year's Day (January 2) MLK Jr. Day (January 16) . CMS also proposed and sought comment on payment for other dental services that were inextricably linked to, and substantially related and integral to, the clinical success of, an otherwise covered medical service, such as dental exams and necessary treatments prior to organ transplants, cardiac valve replacements, and valvuloplasty procedures. Start Preamble AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. CMS proposed to clarify and codify certain aspects of the current Medicare fee-for-services payment policies for dental services. CMS has applied this methodology for these billing codes in the July 2021 ASP Drug Pricing files. Currently, the payment penalty phase of the AUC program is set to begin January 1, 2022. ) The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. The calendar year (CY) 2023 PFS final rule is one of several rules that reflect a broader Administration-wide strategy to create a more equitable health care system that results in better accessibility, quality, affordability, and innovation. Although we expect the increased specimen collection fees for COVID-19 clinical diagnostic laboratory tests will end at the termination of the COVID-19 PHE, we are seeking comments on our policies for specimen collection fees and the travel allowance as we consider updating these policies in the future through notice and comment rulemaking. 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. 7500 Security Boulevard, Baltimore, MD 21244, 2022 Medicare Advantage ratebook and Prescription Drug rate information, An official website of the United States government, July 29, 2021 Parts C & D announcement (PDF), July 29, 2021announcement of 2022Part D National Average Monthly Bid Amount, Medicare Part D Base Beneficiary Premium, Part D Regional Low-Income Premium Subsidy Amounts, Medicare Advantage Regional Benchmarks, and Income Related Monthly Adjustment Amounts, Regional Rates and benchmarks, Part D Low Income Premium Subsidy Amounts, 2022Rate calculation data including statutory benchmark data, USPCC amounts (prospective and retrospective). Sign up to get the latest information about your choice of CMS topics. CMS is proposing to make regulatory changes to implement the new reporting requirements. 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. Official websites use .govA Medicare Advantage Rates & Statistics. When the COVID-19 PHE ends, our regulations will reflect the long-standing ambulance services coverage for the following destinations only: hospital; CAH; SNF; beneficiarys home; and dialysis facility for an ESRD patient who requires dialysis. This includes resubmitting corrected claims that . Currently, there is a nature of payment category for ownership. The service(s) can be billed using the codes audiologists already use with the new modifier, and include only those personally furnished by the audiologist. How the COVID-19 PHE may have impacted costs, and whether health care providers envision these costs to continue. 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. 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. Then, in subsequent years, the limit is updated by the percentage increase in Medicare Economic Index (MEI). CMS is proposing to make conforming technical changes to the regulatory text related to COVID-19 vaccines for RHCs and FQHCs. Dec 20 4. The individual providing the substantive portion must sign and date the medical record. School makeup days will be used in the order listed. The travel allowance is paid only when the nominal specimen collection fee is also payable. Basic Eligibility. website belongs to an official government organization in the United States. 7500 Security Boulevard, Baltimore, MD 21244, Calendar Year (CY) 2022 Medicare Physician Fee Schedule Proposed Rule. This regulatory advisor will summarize some of the key changes, but does not include all provisions. Official websites use .govA An official website of the United States government. or D.O.) The following provisions demonstrate CMSs commitment to addressing health equities in rural and vulnerable populations. Clinical Laboratory Fee Schedule: Laboratory Specimen Collection and Travel Allowance. Preventive Vaccine Administration Services. Section 3713 of the CARES Act established Medicare Part B coverage and payment for a COVID-19 vaccine and its administration. or website belongs to an official government organization in the United States. Based on comments received, CMS is finalizing an increased applicable percentage of 35 percent for this drug. 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). 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. The research payment format allows CMS to verify that the payment is being delayed correctly. Physician-owned distributorships (PODs) are a subset of group purchasing organizations, but are not specifically defined in the Open Payments regulation. Opioid Treatment Program (OTP) Payment Policy. First, we are expanding Medicare coverage for certain colorectal cancer screening tests by reducing the minimum age payment and coverage limitation from 50 to 45 years. 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. CMS proposed to clarify and codify certain aspects of the current Medicare fee-for-services payment policies for dental services. means youve safely connected to the .gov website. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, 2022 NFRM OPPS Statewide CCRs and Upper Limits (ZIP) (ZIP), 2022 NFRM Alternative Statewide CCRs and Upper Limits (ZIP), 2022 NPRM OPPS Statewide CCRs and Upper Limits (ZIP), Alternative 2022 NPRM OPPS Statewide CCRs and Upper Limits (ZIP), CY 2022 Special Wage Index Assignments for Cap on Wage Index Decreases (ZIP), 2022 Procedure Price Lookup Comparison File. You are a child or teenager. This refund applies to refundable single-dose container or single-use package drugs beginning January 1, 2023. hb```e@( Lb! Our policies also directly support President Bidens Cancer Moonshot Goal to cut the death rate from cancer by at least 50 percent over the next 25 years and addresses his recent proclamation of March 2022 as National Colorectal Cancer Awareness Month. We are also proposing to extend the compliance deadline for, Part D prescriptions written for beneficiaries in, Section 405 of the CAA also requires that beginning July 1, 2021, the ASP-based payment limit for billing codes. Only payments that are associated with research should be delayed for publication. We are seeking comment on whether a different interval may be necessary or appropriate for mental health services furnished through audio-only communication technology. After reviewing comments on the proposals, we understand that it would be beneficial to provide interested parties more opportunity to comment on the specific details of changes in coding and payment mechanisms prior to finalizing a specific date when the transition to more appropriate and consistent payment and coding for these products will be completed. ( Share sensitive information only on official, secure websites. We are also finalizing our proposals to codify and clarify various laboratory specimen collection fee policies in 414.523(a)(1). CMS also finalized the proposal to continue the additional payment for at-home COVID-19 vaccinations for CY 2023. Outpatient clinics operated by a tribal organization under the Indian Self-Determination Education and Assistance Act or by an Urban Indian organization receiving funds under title V of the Indian Health Care Improvement Act are eligible to become FQHCs. 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, 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 News and Media Group CMS is also proposing to extend the start date for compliance actions to January 1, 2023, in response to stakeholder feedback. The field would only be visible to the teaching hospital disputing the information. The federal . 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 framework approach is consistent with the concept of paying similar amounts for similar services and with efforts to curb drug prices. However, this process is not available for companies that do not have any records to report. Fri., 12/31/2021 . CMS is engaged in an ongoing review of payment for E/M visit code sets. 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. 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. CMS is finalizing exclusions to this definition as required by statute for drugs that are either radiopharmaceuticals or imaging agents, drugs that require filtration during the drug preparation process, and drugs approved on or after the date of enactment of the Infrastructure Act (that is, November 15, 2021) for which payment under Part B has been made for fewer than 18 months. We are also seeking comment on whether stakeholders believe there are other codes that should be included in this definition to inform future rulemaking. Conforming Technical Changes to the In-Person Requirements for Mental Health Visits. CY 2023 PFS Ratesetting and Conversion Factor. 2022 NFRM Alternative Statewide CCRs and Upper Limits (ZIP) 2022 NPRM OPPS Statewide CCRs and Upper Limits (ZIP) . 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. We are finalizing the addition of 414.523(a)(2) Payment for travel allowance to reflect the requirements for the travel allowance for specimen collection. Given the ongoing stakeholder interest in this issue, the proposed rule includes a comment solicitation to obtain information on the costs involved in furnishing preventive vaccines, with the goal to inform the development of more accurate rates for these services. The refund amount is the amount of discarded drug that exceeds an applicable percentage, which is required to be at least 10%, of total allowed charges for the drug in a given calendar quarter. file delivery for Medicare Advantage or Illinois Medicaid claims. CMS has received a request from the American Indian and Alaska Native community to amend its Medicare regulations to make all IHS- and tribally-operated outpatient facilities/clinics eligible for payment at the Medicare outpatient per visit/AIR, regardless of whether they were owned, operated, or leased by IHS. We are also proposing to clarify and refine policies that were reflected in certain manual provisions that were recently withdrawn. The business center is closed on Saturday & Sunday. We are also proposing to update the payment regulation for MNT services at 414.64 to clarify that MNT services are, and have been, paid at 100% (instead of 80%) of 85% of the PFS amount, without any cost-sharing, since CY 2011. 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. CMS is also finalizing the proposal to allow the OTP intake add-on code to be furnished via two-way audio-video communications technology when billed for the initiation of treatment with buprenorphine, to the extent that the use of audio-video telecommunications technology to initiate treatment with buprenorphine is authorized by the Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA) at the time the service is furnished. website belongs to an official government organization in the United States. Holidays. Payment rates are calculated to include an overall payment update specified by statute. 7500 Security Boulevard, Baltimore, MD 21244, Calendar Year (CY) 2023 Medicare Physician Fee Schedule Final Rule, clinical laboratories, and beneficiaries homes. Per CMS CR#12409, CMS has released the Medicare Physician Fee Schedule. Therefore, we are soliciting comment on these topics that could be used to inform future payment policy decisions. For additional Customer Contact Center closures due to scheduled training exercises, refer to: Scheduled Contact . CMS is also soliciting comment on: (1) whether additional documentation should be required in the patients medical record to support the clinical appropriateness of audio-only telehealth; (2) whether or not we should preclude audio-only telehealth for some high-level services, such as level 4 or 5 E/M visit codes or psychotherapy with crisis; and (3) any additional guardrails we should consider putting in place in order to minimize program integrity and patient safety concerns. Sign up to get the latest information about your choice of CMS topics. Secure .gov websites use HTTPSA lock We believe 12-consecutive months of cost report data accurately reflects the costs of providing RHC services and will establish a more accurate base from which the payment limits will be updated going forward. The calendar year (CY) 2022 PFS proposed rule is one of . We are also proposing to update the payment regulation for MNT services at 414.64 to clarify that MNT services are, and have been, paid at 100% (instead of 80%) of 85% of the PFS amount, without any cost-sharing, since CY 2011. Exempting certain types of independent diagnostic testing facilities (IDTF) from several of our IDTF supplier standards in 42 CFR 410.33. Specifically, in accordance with section 1833(h)(3)(B) of the Act, we are finalizing to include in our regulations the following requirements for the travel allowance methodology: (1) a general requirement, (2) travel allowance basis requirements, and (3) travel allowance amount requirements. 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. Updated Pricing for codes 0596T & 0597T effective February 7, 2022. lock Under Open Payments, there are three kinds of records reported: (1) general (with categories like food and travel), (2) research, and (3) ownership interest. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 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. 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. Holidays: Closed all day, unless otherwise noted. Heres how you know. The 2022 Medicare Physician Fee Schedule is now available in Excel format. Geographic adjusters (geographic practice cost index) are also applied to the total RVUs to account for variation in practice costs by geographic area. The statute provides coverage of MNT services by registered dietitians and nutrition professionals when referred by a physician (an M.D. Both of these policies reflect our desire to expand access to quality care and to improve health outcomes for patients through prevention and early detection services, as well as through effective treatments. You can decide how often to receive updates. Additionally, after consideration of public comments and further analysis, we are finalizing an increase to the nominal fee for specimen collection based on the Consumer Price Index for all Urban Consumers (CPI-U). The Clinical Laboratory Fee Schedule (CLFS) provides for a nominal fee for specimen collection for laboratory testing and a fee to cover transportation and personnel expenses (generally referred to as a travel allowance) for trained personnel to collect specimens from homebound patients and inpatients (not in a hospital). .gov 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. We proposed to rebase and revise the MEI for CY 2023 and solicited comments regarding the future use of the 2017-based MEI weights in PFS ratesetting and the GPCIs. Communication Center: 800-884-1684 (voice), 800-700-2320 (TTY) or California's Relay Service at 711 | contact.center@dfeh.ca.gov At the end of each year, the MAPD Help Desk issues the MARx Monthly Calendarfor the coming year. In instances where the service is not defined in 15-minute increments including: supervised modalities, evaluations/reevaluations, and group therapy. The reduction over time of the coinsurance percentage holds true regardless of the code that is billed for establishment of a diagnosis, for removal of tissue or other matter, or for another procedure that is furnished in connection with and in the same clinical encounter as the screening. Further, section 1814(i)(6) of the Act, as added by section 3132(a)(1)(B) of the PPACA, authorized . This provision permits CMS to apply a payment limit calculation methodology (the lesser of methodology) to applicable billing codes, if deemed appropriate. We confirmed our intention to implement the telehealth provisions in sections 301 through 305 of the CAA, 2022, via program instruction or other subregulatory guidance to ensure a smooth transition after the end of the PHE. .gov Concurrent Billing for Chronic Care Management Services (CCM) and Transitional Care Management (TCM) Services for RHCs and FQHCs. Here's the Social Security holiday schedule for 2023: New Year's Day: Monday, Jan. 2 (observed) Martin Luther King Jr. Day: Monday, Jan. 16. Requiring Certain Manufacturers to Report Drug Pricing Information for Part B. The Division of Ambulatory Services in the CMS Center for Medicare is coordinating the CLFS Annual Public Meeting registration. The practitioner who provides the substantive portion of the visit (more than half of the total time spent) would bill for the visit. These services will be reported with three separate Medicare-specific G codes. Jun 07, 2022 1:00PM - 2:00PM EST Care management is a central theme for the Centers for Medicare & Medicaid Services as a key component of the total care . 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. The CAA, 2022 extends certain flexibilities in place during the PHE for 151 days after the PHE ends, including allowing payment for RHCs and FQHCs for furnishing telehealth services as distant site practitioners (though note that mental health visits can be furnished virtually on a permanent basis) under the payment methodology established for the PHE, allowing telehealth services to be furnished in any geographic area and in any originating site setting, including the beneficiarys home, and allowing certain services to be furnished via audio-only telecommunications systems. 0 the federal holiday schedule tables in the ViPS Medicare System (VMS) on an annual basis. Share sensitive information only on official, secure websites. We have finalized the CPM codes to include the following elements in the code descriptor: diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and coordination between relevant practitioners furnishing care, such as physical and occupational therapy, complementary and integrative care approaches, and community-based care, as appropriate. . On November 01, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates and policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2023.