The finalized direct access policy will allow beneficiaries to receive care for non-acute hearing assessments that are unrelated to disequilibrium, hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids. You have a disability. Proposed revisions to the Medicare Ground Ambulance Data Collection Instrument. Files are listed by core based statistical areas (CBSAs . 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. The final CY 2023 MEI update is 3.8 percent based on the most recent historical data available. Fri., 12/31/2021 . 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). 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 engaged in an ongoing review of payment for E/M visit code sets. 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. CMS has applied this methodology for these billing codes in the July 2021 ASP Drug Pricing files. Additionally, based on the severity of needs of the patient population diagnosed with opioid use disorder (OUD) and receiving services in the OTP setting, CMS is finalizing the proposal to modify the payment rate for the non-drug component of the bundled payments for episodes of care to base the rate for individual therapy on a crosswalk to a code describing a 45-minute session, rather than the current crosswalk to a code describing a 30-minute session. The field would only be visible to the teaching hospital disputing the information. See the 'Urban Area/State Code' and be sure to select the appropriate CBSA to view fees for your facility. Catherine Howden, DirectorMedia Inquiries Form The finalized policy will use a new modifier instead of using a new HCPCS G-code as we proposed because we were persuaded by the commenters that a modifier would allow for better accuracy of reporting and reduce burden for audiologist. The changes proposed for Open Payments in the proposed rule are intended to support the usability and integrity of the data for the public, researchers and CMS. This will increase overall payments for medication-assisted treatment and other treatments for OUD, recognizing the longer therapy sessions that are usually required. Physician-owned distributorships (PODs) are a subset of group purchasing organizations, but are not specifically defined in the Open Payments regulation. Per statutory requirements, we are also updating the data that we use to develop the geographic practice cost indices (GPCIs) and malpractice RVUs. Read More JK and J6 Medicare Part B Ask-the-Contractor Teleconference or lock View the ASC procedures and payment amounts grouped by the Core-Based Statistical Area (CBSA) code. CMS proposed to clarify and codify certain aspects of the current Medicare fee-for-services payment policies for dental services. FY2022 | HHS.gov Columbus Day is on the second Monday of October which falls between October 8th and October 14th. 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. 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 also clarifying that any service furnished primarily for the diagnosis and treatment of a mental health or substance use disorder can be furnished by auxiliary personnel under the general supervision of a physician or NPP who is authorized to furnish and bill for services provided incident to their own professional services. You are a child or teenager. A functional outcome of our policy for a complete colorectal cancer screening will be that, for most beneficiaries, cost sharing will not apply for either the initial stool-based test or the follow-on colonoscopy. Washington's Birthday: Monday, Feb. 20. In addition to cases where one remaining unit of a multi-unit therapy service to be billed, this revision to the policy would apply in a limited number of cases where more than one unit of therapy, with a total time of 24-28 minutes is being furnished. lock 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. As proposed, CMS will base the payment amount for the drug component of HCPCS codes G2067 and G2078 for CY 2023 and subsequent years on the payment amount for methadone in CY 2021 and update this amount annually to account for inflation using the PPI for Pharmaceuticals for Human Use (Prescription). CMS proposed several changes to the policies for skin substitute products to streamline the coding, billing, and payment rules and to establish consistency with these products across the various settings. For CY 2022, in response to numerous stakeholder questions and to promote proper therapy care, CMS is proposing to revise the de minimis standard established to determine whether services are provided in whole or in part by PTAs or OTAs. Physicians services paid under the PFS are furnished in a variety of settings, including physician offices, hospitals, ambulatory surgical centers (ASCs), skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries homes. Payment is also made to several types of suppliers for technical services, most often in settings for which no institutional payment is made. 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. Jan 7 - Fri. Columbus Day is one of the two federal holidays on which the . Share sensitive information only on official, secure websites. lock 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. Contact Information. The dates listed under Part D also apply to MA and cost-based plans offering a Part D benefit. 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. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Access to CMS Systems and Identity Management (IDM) System, Plan Reference Guide for CMS Part C/D Systems, MAPD Plan Communications User Guide (PCUG), 2022 Quarterly Enrollment & Payment Certification Schedule (PDF), 2023 Quarterly Enrollment & Payment Certification Schedule (PDF), Year 2022 MARx Monthly Calendar (text) (PDF), Year 2022 MARx Monthly Calendar (color) (PDF), Year 2023 MARx Monthly Calendar (color) (PDF), Year 2023 MARx Monthly Calendar (text) (PDF), Annual Election Period Begin and End dates, MA Full-Dual Notification File (transmitted only to MA Organizations and Cost Plans). 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. 2022 | CMS - Centers for Medicare & Medicaid Services proposing revisions to the definition of primary care services that are used for purposes of beneficiary assignment. We finalized conforming regulatory text changes in accordance with section 304 of the CAA, 2022 to amend paragraph (b)(3) of 42 CFR 405.2463, What constitutes a visit, and paragraph (d) of 42 CFR 2469, FQHC supplemental payments, to include the delay of the in-person requirements for mental health visits furnished by RHCs and FQHCs through telecommunication technology under Medicare until the 152. CMS is proposing to reduce burden and streamline the Shared Savings Program application process by modifying the prior participation disclosure requirement, so that the disclosure is required only at the request of CMS during the application process, and by reducing the frequency and circumstances under which ACOs submit sample ACO participant agreements and executed ACO participant agreements to CMS. 2022 | CMS - Centers for Medicare & Medicaid Services Ambulatory Surgical Center (ASC) Fee Schedule - 2022 - Novitas Solutions This revised coding and documentation framework includes CPT code definition changes (revisions to the Other E/M code descriptors), including: We finalized the proposal to maintain the current billing policies that apply to the E/Ms while we consider potential revisions that might be necessary in future rulemaking. 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. CMS is finalizing a series of standard technical proposals involving practice expense, including the implementation of the second year of the clinical labor pricing update. Codifying these proposals and revised policies in new regulations at 42 CFR 415.140. 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. Sign up to get the latest information about your choice of CMS topics. or CMS Releases CY 2022 Proposed Rule for Physician Fee Schedule - AHA We finalized new HCPCS codes, G3002 and G3003, and valuation for chronic pain management and treatment services (CPM) for CY 2023. The business center is closed on Saturday & Sunday. We are proposing that the changes would be applicable for determining beneficiary assignment beginning with PY 2022. Medicare Advantage Rates & Statistics. 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. 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. 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. 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. 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. Sign up to get the latest information about your choice of CMS topics. This regulatory advisor will summarize some of the key changes, but does not include all provisions. %%EOF Basic Eligibility | Georgia Medicaid 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. DENTAL GENERAL FEE SCHEDULE 2022 1. Procedure Code 0-20 Year Rate 21 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. Second, we are finalizing our proposed changes and additional clarifications to the Medicare Ground Ambulance Data Collection Instrument. To allow critical care services to be furnished concurrently to the same patient on the same day by more than one practitioner representing more than one specialty, and that critical care services can be furnished as split (or shared) visits. CMS has applied this methodology for these billing codes in the July 2021 ASP Drug Pricing files. It also gives the Secretary authority to enforce non-compliance with the requirement and to specify appropriate penalties for non-compliance through rulemaking. Ambulatory Surgical Center (ASC) fee schedule - 2022. Secure .gov websites use HTTPSA 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. Heres how you know. 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. There is just one federal holiday in October: Columbus Day. The dates listed under Part C include MA and MA-PD plans. 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). 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%. However, Medicare currently pays for dental services in a limited number of circumstances, specifically when that service is an integral part of specific treatment of a beneficiary's primary medical condition. 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%. 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. .gov We also seek comments from stakeholders on the Shared Savings Programs calculation of the regional adjustment, and blended national-regional growth rates for trending and updating the benchmark, as well as comments on the risk adjustment methodology. Section 3713 of the CARES Act established Medicare Part B coverage and payment for a COVID-19 vaccine and its administration. Payment due to Plan. 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 This general record for ownership is separate from ownership and investment interest, which is its own type of record. 202-690-6145. 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. In order to stabilize the price for methadone for CY 2023 and subsequent years, CMS is finalizing the proposal to revise our methodology for pricing the drug component of the methadone weekly bundle and the add-on code for take-home supplies of methadone. This applies to Medicare Part A and Part B. CMS Releases Proposed 2022 Medicare Physician Fee Schedule We are also proposing to. 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. 596 0 obj <> endobj List of Federal Holidays for 2023 and 2024 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. Based on comments received, CMS is finalizing an increased applicable percentage of 35 percent for this drug. New Year's Day 2022. 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. lock CY 2023 PFS Ratesetting and Conversion Factor. 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. MARx Monthly Reports Available. Orthodox Christmas Day 2022. The AMA provides final rule summary (PDF) of the 2023 Medicare Physician Payment Schedule and Quality Payment Program (QPP). Federal government websites often end in .gov or .mil. Epiphany 2022. ) PDF 2022 Holiday Schedule (837 and 835 Transactions) - BCBSIL increased applicable percentage of 35 percent for this drug. means youve safely connected to the .gov website. 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). SUMMARY: This notice announces a $631.00 calendar year (CY) 2022 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 . ASC Payment Rates for 2022 - JF Part B - Noridian 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. The practitioner who provides the substantive portion of the visit (more than half of the total time spent) would bill for the visit. The calendar is available in the Downloads section in both a color and plain text format and identifies the following dates: CMS Holidays. means youve safely connected to the .gov website. Medicare | CMS CMS is proposing to add a required field to teaching hospital records to address this issue. On July 13, 2021, the Centers for Medicare and Medicaid Services (CMS) released an advance copy of the calendar year (CY) 2022 Medicare Physician Fee Schedule (PFS) proposed payment rule.The proposed CY 2022 PFS conversion factor is $33.58, a decrease of $1.31 from the CY 2021 PFS conversion factor of $34.89. 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. 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. PDF 770.49 KB - December 17, 2021 Division/Office. Oct 5 3. 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. 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. CMS is proposing to require that OTPs use a service-level modifier for audio-only services billed using the counseling and therapy add-on code and document in the medical record the rationale for a service being furnished using audio-only services, in order to facilitate program integrity activities. Under the so-called primary care exception, Medicare makes PFS payment in certain teaching hospital primary care centers for certain services furnished by a resident without the physical presence of a teaching physician. 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. clinical laboratories, and beneficiaries homes. Finally, we are working to address commenters thoughtful feedback and questions regarding the operational aspects of billing and claims processing for these services. or D.O.) Christian. lock Several thousand payments in the general payments category are flagged by reporting entities for publication delay in each program year. 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. Tribal FQHC Payments Comment Solicitation. We observe most federal holidays, as well as select additional corporate holidays. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. ASC Drug Fees are also located on the CMS ambulatory surgical center (ASC) payment page. Calendar Year (CY) 2023 Medicare Physician Fee Schedule Final Rule | CMS The research payment format allows CMS to verify that the payment is being delayed correctly. The pandemic has highlighted the importance of access to COVID-19 vaccines, as well as access to other preventive vaccines. Holidays. MAPD/MARx Calendars and Schedules | CMS - Centers for Medicare 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. 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). Determination of ASP for Certain Self-administered Drug Products. Holiday Schedule - JE Part B - Noridian In the PFS proposed rule, we are proposing to implement the second phase of this mandate by proposing certain exceptions to the EPCS requirement. lock However, Medicare currently pays for dental services in a limited number of circumstances, specifically when that service is an integral part of specific treatment of a beneficiary's primary medical condition. CMS is finalizing a series of changes to the Medicare Ground Ambulance Data Collection System. Origin and Destination Requirements Under the Ambulance Fee Schedule. 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. Medicare Cost Plans. Under Open Payments, reporting entities are required to report payments to teaching hospitals. 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. New Year's Day (January 2) MLK Jr. Day (January 16) . Official websites use .govA School makeup days will be used in the order listed. 02:30 PM-03:30 PM,Eastern Time. 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. Holiday Name Calendar Date Legal Banking Holiday Observed Date BCBSIL Holiday Observed Date* New Year's Day 2022 . Weekends: The customer service department is Closed on Saturday and Sunday. To use American Medical Association (AMA) Current Procedural Terminology (CPT) prefatory language as the definition of critical care visits, including bundled services. 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.