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. The calendar is available in the Downloads section in both a color and plain text format and identifies the following dates: CMS Holidays. Dec 20 4. With the budget neutrality adjustments, which are required by law to ensure payment rates for individual services dont result in changes to estimated Medicare spending, the required statutory update to the conversion factor for CY 2023 of 0%, and the expiration of the 3% supplemental increase to PFS payments for CY 2022, the final CY 2023 PFS conversion factor is $33.06, a decrease of $1.55 to the CY 2022 PFS conversion factor of $34.61. Conforming Technical Changes to the In-Person Requirements for Mental Health Visits. 100-04, chapter 16, 60.1., did not have corresponding regulations text and some of the manual guidance is no longer applicable. 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). Jan 7 - Fri. Files are listed by core based statistical areas (CBSAs . This budget reflects the Administration's commitment to serve families across the country, with investments in priority areas, such as maternal health, data and research, tribal health, and early child care and learning. hb```e@( Lb! 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. Start Preamble AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. Based on comments received. Changes to Beneficiary Coinsurance for Additional Procedures Furnished During the Same Clinical Encounter as a Colorectal Cancer Screening. Lastly, in light of questions we have received from interested parties, we are finalizing as proposed to codify in our regulations, and make certain modifications and clarifications to, the Medicare CLFS travel allowance policies. 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. 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 . 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. Clinical Laboratory Fee Schedule: Laboratory Specimen Collection and Travel Allowance. 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. 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. You are legally blind. website belongs to an official government organization in the United States. This regulatory advisor will summarize some of the key changes, but does not include all provisions. 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 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. or An official website of the United States government 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. View the ASC procedures and payment amounts grouped by the Core-Based Statistical Area (CBSA) code. 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. 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. The following provisions demonstrate CMSs commitment to addressing health equities in rural and vulnerable populations. 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. The pandemic has highlighted the importance of access to COVID-19 vaccines, as well as access to other preventive vaccines. An official website of the United States government 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. Sign up to get the latest information about your choice of CMS topics in your inbox. Also beginning April 1, 2021, section 130 as amended requires that a payment limit per-visit be established for smaller provider-based RHCs enrolled before January 1, 2021. 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). Thus, CMS proposes a slight decrease in PFS payment rates of 0.14% in CY 2022. 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). 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). Closed on State holidays. 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. You can decide how often to receive updates. 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. 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. 202-690-6145. We are also proposing to. CMS is finalizing a series of changes to the Medicare Ground Ambulance Data Collection System. ASC Drug Fees are also located on the CMS ambulatory surgical center (ASC) payment page. 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. Customer Support will be closed from 9:30 am - 12 pm CT on the second and fourth . 2022 Holiday Schedule (for 835 and 837 transactions) . 7500 Security Boulevard, Baltimore, MD 21244, Calendar Year (CY) 2022 Medicare Physician Fee Schedule Proposed Rule. Rural HealthClinics (RHCs) and Federally Qualified Health Centers(FQHCs), Chronic Pain Management and Behavioral Health Services. For CY 2022, we are proposing to establish regulations at 410.72 for registered dietitians and nutrition professionals, similar to established regulations for other non-physician practitioners. 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. 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. %%EOF Ambulatory Surgical Center Dental, Federally Qualified Health Center Dental, General Dental, and Rural Health Center Dental fee schedules prior to Nov. 3, including archives, are available at the links below.Please follow these steps to look up the plan's maximum allowable for many . Per statutory requirements, we are also updating the data that we use to develop the geographic practice cost indices (GPCIs) and malpractice RVUs. 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. lock We are proposing that the changes would be applicable for determining beneficiary assignment beginning with PY 2022. website belongs to an official government organization in the United States. Sign up to get the latest information about your choice of CMS topics. When both the PTA/OTA and the PT/OT each furnish less than eight minutes for the final 15-minute unit of a billing scenario. 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). Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). 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). Requiring reporting of a modifier on the claim to help ensure program integrity. This applies to Medicare Part A and Part B. Please refer to the chart below for important answers to common questions. CMS is also proposing to extend the start date for compliance actions to January 1, 2023, in response to stakeholder feedback. This calendar schedule will assist in determining the 60th day from the start of care (SOC) date. Based on comments received, CMS is finalizing an increased applicable percentage of 35 percent for this drug. Updates to the Open Payments Financial Transparency Program. 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. 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. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 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. 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. The business center is open daily from 8:30 am to 4:30 pm, local time. View below dates indicate when Noridian operations, including the Contact Center phone lines, will be unavailable for customer service. Section 405 of the CAA requires the Office of Inspector General (OIG) to conduct periodic studies on non-covered, self-administered versions of drugs or biologicals that are included in the calculation of payment under section 1847A of the Social Security Act. 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. Plan Submission Cut-Off. 596 0 obj <> endobj -425. 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. Second, we are finalizing our proposed changes and additional clarifications to the Medicare Ground Ambulance Data Collection Instrument. The CAA, 2022 also delays the in-person visit requirements for mental health visits via telecommunications technology, including those furnished by RHCs and FQHCs, until 152 days after the end of the PHE. New Year's Day (January 2) MLK Jr. Day (January 16) . 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. CMS is proposing to require an in-person, non-telehealth service be provided by the physician or practitioner furnishing mental health telehealth services within six months prior to the initial telehealth service, and at least once every six months thereafter. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 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. Section 122 of the CAA reduces, over time, the amount of coinsurance a beneficiary will pay for such services. This includes resubmitting corrected claims that . Several thousand payments in the general payments category are flagged by reporting entities for publication delay in each program year. CMS proposed to clarify and codify certain aspects of the current Medicare fee-for-services payment policies for dental services. In the CY 2023 HH PPS proposed rule (87 FR 37605), CMS provided data analysis on Medicare home health benefit utilization, including overall total 30-day periods of care and average periods of care per HHA user; distribution of the type of visits in a 30-day period of care for all Medicare fee-for-service (FFS) claims; the percentage of periods that receive the LUPA; estimated costs for 30-day . Call To Action. 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. Columbus Day is one of the two federal holidays on which the . 100-04, chapter 16, 60.1., did not have corresponding regulations text and some of the manual guidance is no longer applicable. Split (or shared) visits could be reported for new as well as established patients, and initial and subsequent visits, as well as prolonged services. 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. The purpose of this delay is to keep a record from being publicly available because it contains sensitive information for research and development. 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. These policies, such as allowing telehealth services to be furnished in any geographic area and in any originating site setting (including the beneficiarys home); allowing certain services to be furnished via audio-only telecommunications systems; and allowing physical therapists, occupational therapists, speech-language pathologists, and audiologists to furnish telehealth services, will remain in place during the PHE for 151 days after the PHE ends. proposing revisions to the definition of primary care services that are used for purposes of beneficiary assignment. 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. %PDF-1.6 % 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. We are also seeking comments related to the calculation of costs for transportation and personnel expenses for trained personnel to collect specimens from such patients. . 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. 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. The potential conflict of interest between providers and reporting entities is the heart of the Open Payments program, so quick and clear identification of physician-owned businesses would be beneficial. March 3: Social Security payments for those who receive both SSI . First, we are finalizing our proposal to update our regulations at 414.626(d)(1) and (e)(2) to provide the necessary flexibility to specify how ground ambulance organizations should submit the hardship exemption requests and informal review requests, including to our web-based portal once that portal is operational. To review the entire final rule, visit the Federal Register. The CAA, 2022, also delays the in-person visit requirements for mental health services furnished via telehealth until 152 days after the end of the PHE. 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. Catherine Howden, DirectorMedia Inquiries Form 2022 NFRM Alternative Statewide CCRs and Upper Limits (ZIP) 2022 NPRM OPPS Statewide CCRs and Upper Limits (ZIP) . Federal government websites often end in .gov or .mil. 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. 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). In the proposed rule, CMS proposed that an initial invoice for the refund to be sent to manufacturers in October 2023. 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. 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. 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. 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. 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. 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). See the below for the following updates: Updated Pricing for codes G0339, G0340, 0275T, 0598T & 0599T effective January 1, 2022. NC Medicaid Division of Health Benefits. lock 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. 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 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 has applied this methodology for these billing codes in the July 2021 ASP Drug Pricing files. 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. 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. 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%. Section 2003 of the SUPPORT Act requires electronic prescribing of controlled substances (EPCS) for schedule II, III, IV, and V controlled substances covered through Medicare Part D. The statute provides the Secretary with discretion on whether to grant waivers or exceptions to the EPCS requirement and specifies several types of exceptions that may be considered. Official websites use .govA Further, section 1814(i)(6) of the Act, as added by section 3132(a)(1)(B) of the PPACA, authorized . . 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. 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 . Heres how you know. . We are exploring how these policies interact with the Shared Savings Programs other benchmarking policies. Federal government websites often end in .gov or .mil. MAPD/MARx Calendars and Schedules. Share sensitive information only on official, secure websites. endstream endobj 597 0 obj <. In addition, we are finalizing a policy to update this fee amount annually by the percent change in the CPI-U. 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. Secure .gov websites use HTTPSA Only payments that are associated with research should be delayed for publication. Through review of questions and feedback that we received, we have identified some instances where changes and clarifications to the instrument could improve clarity and be less burdensome to respondents. These claims will require the modifier 95 to identify them as services furnished as telehealth services. Origin and Destination Requirements Under the Ambulance Fee Schedule. 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. The business center is closed on Saturday & Sunday. See the 'Urban Area/State Code' and be sure to select the appropriate CBSA to view fees for your facility. To address this, CMS is proposing language that will clarify the impermissibility of delaying general payments, and that research-related payments do not need to have been specifically outlined in the original research agreement to be reported as research payments. FQHCs are paid under the FQHC Prospective Payment System (PPS) under Medicare Part B based on the lesser of the FQHC PPS rate or their actual charges.