Share sensitive information only on official, secure websites. 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. CMS is proposing to add a required field to teaching hospital records to address this issue. 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. Section 405 of the CAA also requires that beginning July 1, 2021, the ASP-based payment limit for billing codes representing Cimzia (certolizumab pegol) and Orencia (abatacept) as identified in a July 2020 OIG report adhere to the lesser of methodology. Only payments that are associated with research should be delayed for publication. CMS is proposing the lesser of methodology for drug and biological products that may be identified by future OIG reports. An official website of the United States government. Therefore, for CY 2023, the general specimen collection fee will increase from $3 to $8.574 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 . 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. and also establishes the professional qualifications for these practitioners. Sign up to get the latest information about your choice of CMS topics in your inbox. At the end of each year, the MAPD Help Desk issues the MARx Monthly Calendarfor the coming year. Customer Support will be closed from 9:30 am - 12 pm CT on the second and fourth . There is just one federal holiday in October: Columbus Day. Payment due to Plan. 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. Files are listed by core based statistical areas (CBSAs . 202-690-6145. Section 130 of the CAA as amended by section 2 of P.L. Share sensitive information only on official, secure websites. Medicare Manuals. The 2022 Medicare Physician Fee Schedule is now available in Excel format. 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. endstream endobj startxref You can decide how often to receive updates. 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. 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. CMS is finalizing requirements for the use of the JW modifier, for reporting discarded amounts of drugs, and the JZ modifier, for attesting that there were no discarded amounts. Spending time (more than half of the total time spent by the practitioner who bills the visit). clinical laboratories, and beneficiaries homes. 7500 Security Boulevard, Baltimore, MD 21244, Calendar Year (CY) 2023 Medicare Physician Fee Schedule Final Rule, clinical laboratories, and beneficiaries homes. 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). First, we are seeking input on our preliminary policy to pay $35 add-on for certain vulnerable beneficiaries when they receive a COVID-19 vaccine at home. 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 . 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. Specifically, we are finalizing revisions to 414.507(d) to indicate that for CY 2022, payment may not be reduced by more than 0% as compared to the amount established for CY 2021, and for CYs 2023 through 2025, payment may not be reduced by more than 15% as compared to the amount established for the preceding year. Medicare payment for dental services is generally precluded by statute. For CY 2022, in response to numerous stakeholder questions and to promote proper therapy care, CMS is proposing to revise the. An official website of the United States government 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. April 14 July 4 is a holiday for 12-month employees only This calendar reects the 2022-2023 academic calendar approved by the Board of Education on July 13, 2021. ( 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 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. View below dates indicate when Noridian operations, including the Contact Center phone lines, will be unavailable for customer service. Basic Eligibility. This reflects the expiration of the 3.75% payment increase, a 0% update factor as required by the . CMS is proposing to limit the use of an audio-only interactive telecommunications system to mental health services furnished by practitioners who have the capability to furnish two-way, audio/video communications, but where the beneficiary is not capable of using, or does not consent to, the use of two-way, audio/video technology. 2022; Tools to Improve Your Billing . A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 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. ) Changes to Beneficiary Coinsurance for Additional Procedures Furnished During the Same Clinical Encounter as a Colorectal Cancer Screening. 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. We are also seeking comment on whether stakeholders believe there are other codes that should be included in this definition to inform future rulemaking. We are seeking comment on whether a different interval may be necessary or appropriate for mental health services furnished through audio-only communication technology. Holidays 11 Last day of Quarter Early Release Days Makeup Days: 1. 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. The dates listed under Part C include MA and MA-PD plans. See the below for the following updates: Updated Pricing for codes G0339, G0340, 0275T, 0598T & 0599T effective January 1, 2022. 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. 202-690-6145. 117-7, requires that, beginning April 1, 2021, independent RHCs and provider-based RHCs in a hospital with 50 or more beds receive an increase in their payment limit per visit over an 8-year period, with a prescribed amount for each year from 2021 through 2028. Updates to the Open Payments Financial Transparency Program. This includes resubmitting corrected claims that . . 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. from March quarter 2008-09 to December quarter 2022-23. Expanding our authority to deny or revoke a providers or suppliers Medicare enrollment in order to protect the Medicare program and its beneficiaries. and also establishes the professional qualifications for these practitioners. We are also finalizing revisions to 414.504(a)(1) to indicate that initially, data reporting begins January 1, 2017 and is required every 3 years beginning January 2023. The federal . and also establishes the professional qualifications for these practitioners. Secure .gov websites use HTTPSA n$4ldjz2;$::@Dh@ L+600g QQi7,n1s2s9BeBc`De@9 H10(="*U%` + CMS is proposing to clarify that the time when the teaching physician was present can be included when determining E/M visit level. CMS is proposing revisions to the definition of primary care services that are used for purposes of beneficiary assignment. Recertification is part of the annual process that reporting entities undertake when they submit records, primarily allowing for the companies to update their system information. 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. CMS is proposing a series of changes to the Medicare Ground Ambulance Data Collection System including: For more information, please visit:https://www.federalregister.gov/public-inspection/current, CMS News and Media Group 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. Official websites use .govA . Per CMS CR#12409, CMS has released the Medicare Physician Fee Schedule. Several thousand payments in the general payments category are flagged by reporting entities for publication delay in each program year. Sign up to get the latest information about your choice of CMS topics. 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. 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 . The AMA provides final rule summary (PDF) of the 2023 Medicare Physician Payment Schedule and Quality Payment Program (QPP). Payments are based on the relative resources typically used to furnish the service. In addition, we have been asked to consider certain flexibilities regarding the cost reporting requirement for these types of facilities. Finalizing the use of the 2017-based MEI cost weights to set PFS rates would not change overall spending on PFS services, but would result in significant distributional changes to payments among PFS services across specialties and geographies. 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. lock We also included a comment solicitation seeking public input as we develop a more consistent, predictable approach to incorporating new data in setting PFS rates. 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. Catherine Howden, DirectorMedia Inquiries Form Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 10872 Date: July 2, 2021 . The fee schedules below are effective for dates of service January 1, 2022, through December 31, 2022. Lastly, CMS is finalizing the proposal to 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. If we determine changes to our existing policies are needed, we would propose modifications in subsequent rulemaking. Under the primary care exception specifically, only MDM would be used to select the visit level to guard against the possibility of inappropriate coding that reflects residents inefficiencies rather than a measure of the time required to furnish the services. 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%. CMS is soliciting comment on a decision framework under which certain section 505(b)(2) drug products could be assigned to existing multiple source drug codes. These RVUs become payment rates through the application of a conversion factor. 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. 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. lock 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. 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. 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). This calendar schedule will assist in determining the 60th day from the start of care (SOC) date. 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. CMS is proposing a series of standard technical proposals involving practice expense, including the implementation of the fourth year of the market-based supply and equipment pricing update, changes to the practice expense for many services associated with the proposed update to clinical labor pricing, and standard rate-setting refinements. CMS is implementing the final part of section 53107 of the Bipartisan Budget Act of 2018, which requires CMS, through the use of new modifiers (CQ and CO), to identify and make payment at 85% of the otherwise applicable Part B payment amount for physical therapy and occupational therapy services furnished in whole or in part by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs), for dates of service on and after January 1, 2022. 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. CMS believes that this change will facilitate access and extend the reach of behavioral health services. Finally, CMS indicated in the final rule that we intend to address payment for new codes that describe caregiver behavioral management training in CY 2024 rulemaking. Federal government websites often end in .gov or .mil. The dates listed under Part D also apply to MA and cost-based plans offering a Part D benefit. 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. In the proposed rule, CMS proposed that an initial invoice for the refund to be sent to manufacturers in October 2023. Requiring Certain Manufacturers to Report Drug Pricing Information for Part B. The practitioner who provides the substantive portion of the visit (more than half of the total time spent) would bill for the visit. 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. Start Preamble AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. Medigap (Medicare Supplement Health Insurance) Medical Savings Account (MSA) Private Fee-for-Service Plans. Orthodox Christmas Day 2022. 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. However, we are soliciting comment on whether the original date of January 1, 2022, should remain, in light of the proposed exceptions to the mandate. Holiday Name Calendar Date Legal Banking Holiday Observed Date BCBSIL Holiday Observed Date* New Year's Day 2022 . We are also proposing to allow a one-time opportunity for certain ACOs that established a repayment mechanism to support their participation in a two-sided model beginning on July 1, 2019; January 1, 2020; or January 1, 2021; to elect to decrease the amount of their existing repayment mechanisms. Open Payments is a national transparency program that requires drug and device manufacturers and group purchasing organizations (known as reporting entities) to report payments or transfers of value to physicians, teaching hospitals, and other providers (known as covered recipients) to CMS. Finally, we are working to address commenters thoughtful feedback and questions regarding the operational aspects of billing and claims processing for these services. 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 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. That critical care visits cannot be reported during the same time period as a procedure with a global surgical period. This regulatory advisor will summarize some of the key changes, but does not include all provisions. 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 $10.57 specimen collection fee for those beneficiaries . Therefore, CMS is finalizing the proposal to add an exception to the direct supervision requirement under our incident to regulation at 42 CFR 410.26 to allow behavioral health services to be provided under the general supervision of a physician or non-physician practitioner (NPP), rather than under direct supervision, when these services or supplies are furnished by auxiliary personnel, such as LPCs and LMFTs, incident to the services of a physician (or NPP). CMS is finalizing a series of changes to the Medicare Ground Ambulance Data Collection System. When the PTA/OTA furnishes eight minutes or more of the final unit of a billing scenario in which the PT/OT furnishes less than eight minutes of the same service. You may be eligible for Medicaid if your income is low and you match one of the following descriptions: You think you are pregnant. The statute provides coverage of MNT services by registered dietitians and nutrition professionals, when referred by a physician (an M.D. 616 0 obj <>/Filter/FlateDecode/ID[<93B9AE44C85DD84DBD2BDB2B6969AAC0>]/Index[596 30]/Info 595 0 R/Length 103/Prev 230955/Root 597 0 R/Size 626/Type/XRef/W[1 3 1]>>stream This is because the policies implementing the statutory requirements under section 1833(h)(3)(A) of the Act for the laboratory specimen collection fee, which are currently described in the Medicare Claims Processing Manual Pub. This proposal will simplify communication about compliance between reporting entities and CMS. This fee schedule takes effect January 1, 2022, so make sure your office staff are aware of the new information. hbbd```b``+@$Ln`,r~"YwEO0&y$ v;5H[x lN0 = SUMMARY: This notice announces a $688.00 calendar year (CY) 2023 application fee for institutional providers that are initially enrolling in the Medicare or Medicaid program or the Children's Health Insurance Program (CHIP); revalidating their Medicare, Medicaid, or CHIP enrollment; or adding a new . An official website of the United States government 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. In light of the current needs among Medicare beneficiaries for improved access to behavioral health services, CMS has considered regulatory revisions that may help to reduce existing barriers and make greater use of the services of behavioral health professionals, such as licensed professional counselors (LPCs) and Licensed Marriage and Family Therapists (LMFTs). Plan Submission Cut-Off. 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 . 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. 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. Payment is also made to several types of suppliers for technical services, most often in settings for which no institutional payment is made. Documentation in the medical record that would identify the two individuals who performed the visit. -420. For CY 2022, we are making several proposals that take into account the recent changes to E/M visit codes, as explained in the AMA CPT Codebook, which took effect January 1, 2021. 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. -425. Medical Nutrition Therapy Coverage and Payment Issues. 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. Beginning May 2, 2022 and ending June 2, 2022, registration may be completed by presenters only. Under the exception, grandfathered tribal FQHCs bill as if it were provider-based to an Indian Health Service (IHS) hospital and are paid the Medicare outpatient per visit rate, also referred to as the IHS all-inclusive rate (AIR). CMS is also proposing to require use of a new modifier for services furnished using audio-only communications, which would serve to certify that the practitioner had the capability to provide two-way, audio/video technology, but instead, used audio-only technology due to beneficiary choice or limitations. We also finalized creation of Medicare-specific coding for payment of Other E/M prolonged services, similar to what CMS adopted in CY 2021 for payment of Office/Outpatient prolonged services. ( Exempting certain types of independent diagnostic testing facilities (IDTF) from several of our IDTF supplier standards in 42 CFR 410.33. 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. 02:30 PM-03:30 PM,Eastern Time. Some drugs approved through the pathway established under section 505(b)(2) of the Federal Food, Drug, and Cosmetic Act share similar labeling and uses with generic drugs that are assigned to multiple source drug codes. CMS has applied this methodology for these billing codes in the July 2021 ASP Drug Pricing files. Eliminated use of history and exam to determine code level (instead there would be a requirement for a medically appropriate history and exam). The FY 2022 budget proposes $131.8billion in discretionary budget authority and $1.5 trillion in mandatory funding. 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.