On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) released the 2024 proposed rule for Medicare Physician Payment Schedule (MFS) and other changes to Part B Payment and Coverage Policies. If finalized, these policies will take effect on January 1, 2024, unless otherwise noted. Interested parties have a 60-day comment period, which ends on September 11, 2023, to provide feedback and comments on the proposed rule.
This proposed rule includes several crucial provisions that could significantly impact Medicare physician payment. Some of the key areas from the rule include:
• Reduction of the PFS Conversion Factor: The proposed rule predicts a 3.36 percent reduction in the 2024 Medicare conversion factor, lowering it from $33.89 to $32.75. Additionally, the anesthesia conversion factor is proposed to be reduced from $21.12 to $20.44.
• A nationwide lobbying effort is underway to create long-term stability for providers participating in the Medicare program. The AMA is encouraging physicians to get involved through Fix Medicare Now and join the efforts to preserve access to care for Medicare beneficiaries. Link: https://urldefense.com
• Reintroduction of the Evaluation and Management (E/M) Add-on Code: Considering feedback from the draft rule 2023, CMS felt they over-estimated the utilization of the new E/M add-on code, G2211 if implemented this year. Despite this, if its approved for 2024, the code will lead to additional across-the-board cuts due to budget neutrality requirements. G2211 is defined as - Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition. (Add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established). CMS clarifies that it will not allow payment for G2211 when reported on the same date as an E/M visit reported with modifier -25. CMS is requesting public comment on the future of E/M services to ensure payment is relative to the service being performed.
• Among other Relative Value revisions, CMS is proposing to increase maternity services to incorporate increases to the hospital (E/M), consistent with the RUC recommendations to incorporate the E/M increases into post-operative office and hospital visits in codes with global periods.
• Split/shared rules would be delayed through calendar year 2024 due to feedback that the time rule alone would disrupt providers in the facility setting. Under the current rule, physicians would continue to bill split/shared visits based on the current definition of substantive portion as one of the following: history, or exam, or medical decision-making, or more than half of total time.
• CMS is implementing the telehealth flexibilities that were included in the Consolidated Appropriations Act 2023 (CAA) by waiving the geographic and originating site requirements for Medicare telehealth services through the end of CY 2024. This will allow beneficiaries to receive telehealth services in their home. Audio-only telephone visits will also be extended along with the requirement for a face-to-face visit before an audio-only mental health visit. CPT codes 99441 through 99443 will remain actively priced through 2024. CMS is proposing to continue to assign an active payment status to CPT codes 98966 through 98968 for CY 2024 to align with telehealth-related flexibilities. Other telehealth items on the table include keeping telehealth payment at the non-facility rate if the patient is at home, lifting frequency visits for SNF and subsequent hospital, and continuing to allow virtual supervision in a teaching setting.
• The billing rules for RTM and RPM will not change despite public comment that the 16-day rule for billing and established requirement are too restrictive. CMS responded this will not change for 2024. Yet, CMS will propose to allow RHC/FQHC’s to bill for these services under HCPCS code G0511 to align with current rulemaking.
• Diabetes programing is evolving with clarification on the types of providers that can bill for self-management training. CMS is also adding the hemoglobin A1C to the list of screening tests for pre-diabetes. This will be capped at 2 tests in a rolling 12-month period.
• Section 4121(a)(1) of the Consolidated Appropriations Act of 2023 amended section 1861(s)(2) by adding a new benefit category under Medicare Part B to include marriage and family therapist (MFT) and mental health counselor services (MHC). This would allow them to bill and receive payment from the Medicare program. This would also include eligible telehealth services.
• Under the same Act, Section 1848(b), crisis services during psychotherapy will receive a rate increase of 150% in a non-facility setting. Two new codes are proposed for the non- facility site of services outside of physician’s office. Behavioral health supervision is also being considered in a RHC/FQHC setting as auxiliary personnel must be under direct supervision for certain services. To align with other areas of the fee schedule, CMS is proposing to move this to general supervision.
• Given the need for transitional patient care outside of a facility, CMS proposes to establish an active payment status for CPT codes 96202 and 96203, caregiver behavior management/modification training services. New codes will also be established for caregiver training services under a therapy plan of care established by a PT, OT, SLP. These codes allow treating practitioners to report the training furnished to a caregiver, in tandem with the diagnostic and treatment services furnished directly to the patient.
• Telehealth modifier rules were finalized through CY 2023 to continue using -95 and the placer of service (POS) where the service would have taken place. Starting CY 2024, POS 10 Telehealth provided in patient's home or POS 02 Telehealth provided other than in patient's home should be used. This will replace the need for modifier 95.
• CMS will maintain virtual direct supervision as they believe providers will need time to reorganize their practice patterns established during the pandemic to reimplement the pre- PHE approach without the use of audio/video technology. The draft rule proposes to define direct supervision to permit the presence and “immediate availability” of the supervising practitioner through real-time audio and visual interactive telecommunications through December 31, 2024.
To read the CMS press release, see https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy- 2024-medicare-physician-fee-schedule-proposed-rule
To find the AMA’s specialty Impact Analysis, see https://www.ama-assn.org/system/files/estimated- specialty-impact-analysis.pdf