or D.O.) 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 . We finalized new HCPCS codes, G3002 and G3003, and valuation for chronic pain management and treatment services (CPM) for CY 2023. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. The business center is open daily from 8:30 am to 4:30 pm, local time. 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. 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. The purpose of this delay is to keep a record from being publicly available because it contains sensitive information for research and development. Physician-owned distributorships (PODs) are a subset of group purchasing organizations, but are not specifically defined in the Open Payments regulation. Washington's Birthday: Monday, Feb. 20. ACTION: Notice. We proposed to rebase and revise the MEI for CY 2023 and solicited comments regarding the future use of the 2017-based MEI weights in PFS ratesetting and the GPCIs. Heres how you know. 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. 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). CY 2022 PFS Ratesetting and Conversion Factor. and also establishes the professional qualifications for these practitioners. Federal Holiday. Finally, we are working to address commenters thoughtful feedback and questions regarding the operational aspects of billing and claims processing for these services. In this rule, CMS finalized refinements to the payment amount for preventive vaccine administration under the Medicare Part B vaccine benefit, which includes the influenza, pneumococcal, hepatitis B, and COVID-19 vaccine and their administration. 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. 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. Before sharing sensitive information, make sure youre on a federal government site. 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. Laboratory Fee Schedule - Jan. 1, 2022 - PDF. For prescribers who are in the geographic area of a natural disaster, or who are granted a waiver based on extraordinary circumstances, such as an influx of patients due to a pandemic. March 3: Social Security payments for those who receive both SSI . Sign up to get the latest information about your choice of CMS topics. ( 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. 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. %PDF-1.6 % website belongs to an official government organization in the United States. 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. website belongs to an official government organization in the United States. There is just one federal holiday in October: Columbus Day. 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. . 0 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. 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. 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. -420. Relative value units (RVUs) are applied to each service for work, practice expense, and malpractice expense. Conforming Technical Changes to the In-Person Requirements for Mental Health Visits. CMS is proposing to give companies the option to recertify and attest to the fact that they do not have any records to submit for a reporting year. The statute provides coverage of MNT services that may only be provided by registered dietitians and nutrition professionals when referred by a physician (an M.D. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. 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). As a health practitioner you must meet certain requirements to bill for Medicare Benefits Schedule (MBS) items under Medicare or prescribe subsidised medicines. At the end of each year, the MAPD Help Desk issues the MARx Monthly Calendarfor the coming year. Home Health 60-day Episode Calendar Schedule SOC Date End of Episode 01/01 thru 03/01 01/02 thru 03/02 01/03 thru 03/03 01/04 thru 03/04 01/05 thru 03/05 01/06 thru 03/06 01/07 thru 03/07 01/08 thru 03/08 100-04, chapter 16, 60.1., did not have corresponding regulations text and some of the manual guidance is no longer applicable. the federal holiday schedule tables in the ViPS Medicare System (VMS) on an annual basis. CMS is engaged in an ongoing review of payment for E/M visit code sets. The calendar year (CY) 2022 PFS proposed rule is one of . In December 2020, CMS implemented the first phase of this mandate by naming the standard that prescribers must use for EPCS transmissions and delaying compliance actions until January 1, 2022. CMS is also finalizing the proposal to allow a psychiatric diagnostic evaluation to serve as the initiating visit for the new general BHI service. These proposals, in addition to existing policies, provide three years for ACOs to transition to reporting the three eCQM/MIPS CQM all-payer measures under the APP. Drug manufacturers with Medicaid Drug Rebate Agreements are required to submit Average Sales Price (ASP) data for their Part B products in order for their covered outpatient drugs to be payable under Part B. We will take into account the comments we received in response to CY 2023 rulemaking and feedback received in association with the Town Hall in order to strengthen proposed policies for skin substitutes in future rulemaking. These RVUs become payment rates through the application of a conversion factor. For additional Customer Contact Center closures due to scheduled training exercises, refer to: Scheduled Contact . Section 3713 of the CARES Act established Medicare Part B coverage and payment for a COVID-19 vaccine and its administration. Official websites use .govA 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. Holidays 11 Last day of Quarter Early Release Days Makeup Days: 1. 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. 202-690-6145. Basic Eligibility. .gov Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). You have a disability. Heres how you know. In addition, we have been asked to consider certain flexibilities regarding the cost reporting requirement for these types of facilities. lock hb```e@( Lb! 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. This calendar schedule will assist in determining the 60th day from the start of care (SOC) date. 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 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. or Federal government websites often end in .gov or .mil. COVID-19 Vaccines Furnished in RHCs and FQHCs (Technical Updates). When the PTA/OTA independently furnishes a service, or a 15-minute unit of a service in whole without the PT/OT furnishing any part of the same service. 7500 Security Boulevard, Baltimore, MD 21244 . 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. You can decide how often to receive updates. CMS is proposing to begin the payment penalty phase of the AUC program on the later of January 1, 2023, or the January 1 that follows the declared end of the PHE for COVID-19. We are proposing that the changes would be applicable for determining beneficiary assignment beginning with PY 2022. Before sharing sensitive information, make sure youre on a federal government site. In addition, we are finalizing a policy to update this fee amount annually by the percent change in the CPI-U. 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. endstream endobj startxref CMS is finalizing the proposal that locality adjustments for services furnished via mobile units would be applied as if the service were furnished at the physical location of the OTP registered with DEA and certified by SAMHSA. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. For CY 2022, in response to stakeholder concerns about parity with other types of NPPs, we are proposing to establish regulations at 410.72 for their services since they are the only NPP type listed at section 1842(b)(18)(C) of the Act without a regulatory provision in this section of 42 CFR subpart B. 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. . Preventive Vaccine Administration Services. 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. 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. 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. 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. The final CY 2023 MEI update is 3.8 percent based on the most recent historical data available. Spending time (more than half of the total time spent by the practitioner who bills the visit). This will increase overall payments for medication-assisted treatment and other treatments for OUD, recognizing the longer therapy sessions that are usually required. endstream endobj 597 0 obj <. Under the proposal, physicians would see a decrease of $1.31 in the conversion factor on Jan. 1, 2022, going from $34.89 . MARx Monthly Reports Available. 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. Oct 5 3. In addition, we are finalizing a policy to update this fee amount annually by the percent change in the CPI-U. For drugs with unique circumstances, CMS 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. In the PFS proposed rule, we are proposing to implement the second phase of this mandate by proposing certain exceptions to the EPCS requirement. We are exploring how these policies interact with the Shared Savings Programs other benchmarking policies. 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. 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 . Here's the March schedule (PDF) for when you should get your Social Security check and/or SSI money: March 1: March SSI payments. 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. CMS is finalizing that providers will be required to report the JW modifier beginning January 1, 2023 and the JZ modifier no later than July 1, 2023 in all outpatient settings. However, we solicited comments on the potential use of the proposed updated MEI cost share weights to calibrate payment rates and update the GPCI under the PFS in the future. ASC Drug Fees are also located on the CMS ambulatory surgical center (ASC) payment page. CMS is proposing to allow RHCs and FQHCs to bill for TCM and other care management services furnished for the same beneficiary during the same service period, provided all requirements for billing each code are met. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). 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. 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. 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). An official website of the United States government. Under Open Payments, reporting entities are required to report payments to teaching hospitals. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. This fee schedule takes effect January 1, 2022, so make sure your office staff are aware of the new information. The calendar is available in the Downloads section in both a color and plain text format and identifies the following dates: CMS Holidays. ; 2023 or D.O.) -425. Eliminated use of history and exam to determine code level (instead there would be a requirement for a medically appropriate history and exam). The following provisions demonstrate CMSs commitment to addressing health equities in rural and vulnerable populations. 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. Plan Submission Cut-Off. This schedule lists holiday closures for the First Coast offices and provider contact centers responsible for serving providers in Florida, Puerto Rico, and the U.S. Virgin Islands. This applies to Medicare Part A and Part B. 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. Origin and Destination Requirements Under the Ambulance Fee Schedule. The CAA, 2022 extends certain flexibilities in place during the PHE for 151 days after the PHE ends, including allowing payment for RHCs and FQHCs for furnishing telehealth services as distant site practitioners (though note that mental health visits can be furnished virtually on a permanent basis) under the payment methodology established for the PHE, allowing telehealth services to be furnished in any geographic area and in any originating site setting, including the beneficiarys home, and allowing certain services to be furnished via audio-only telecommunications systems. You can decide how often to receive updates. ACOs accepting performance-based risk must establish a repayment mechanism (i.e, escrow, line of credit, surety bond) to assure CMS that they can repay losses for which they may be liable upon reconciliation. 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 . A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Sign up to get the latest information about your choice of CMS topics. Official websites use .govA 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. The Medicare Benefit Policy Manual recognizes that although most beneficiaries are unable to leave their facility, 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. Since the requirements for the chronic pain management and behavioral health integration services are similar to the requirements for the general care management services furnished by RHCs and FQHCs (which are the current services for which RHCs and FQHCs can use HCPCS code G0511) the payment rate for HCPCS code G0511 will continue to be the average of the national non-facility PFS payment rates for the RHC and FQHC care management and general behavioral health codes (CPT codes 99484, 99487, 99490, and 99491) and PCM codes (CPT codes 99424 and 99425) Payment will be updated annually based on the PFS amounts for these codes, which is how these updates are made currently. 2022 Holiday Schedule (for 835 and 837 transactions) .
