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Coding Corner

On July 13, 2021, The Centers for Medicare and Medicaid Services (CMS) released a proposed rule containing updates to payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) for 2022. This rule includes updates to payment rates for providers, expansions to telehealth, refinement to evaluation and management policies, proposes policies pertaining to quality payment programs for the 2022 performance year, as well as many other conditions.

To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on September 13, 2021.


Physician Fee Schedule Highlights

Conversion Factor: Reduces the conversion factor from $34.89 in calendar year 2021 to $33.58 for calendar year 2022, a decrease of $1.31. This is a result of the expiration of a 3.75 percent increase in PFS payment amounts for services furnished on or after January 1, 2021, and before January 1, 2022.

Telehealth: Allowing certain services that were added to the telehealth list during the COVID-19 PHE to remain on the list to the end of December 31, 2023, which will afford time to evaluate whether the services should be permanently added to the telehealth list following the COVID-19 PHE.

Telehealth Services for Mental Health:

  • Removed the geographic restrictions and added the home of the beneficiary as a permissible originating site for telehealth services when used for the purposes of diagnosis, evaluation, or treatment of a mental health disorder
  • Requires that there be an in-person, non-telehealth service with the physician or practitioner within six months prior to the initial telehealth service, and at least once every six months thereafter.
  • Allow RHCs and FQHCs to report and received payment for mental health visits furnished via Telehealth
  • Allow payment for behavioral health services to patients by means of audio-only telephone calls from their homes, including counseling and therapy services provided through Opioid Treatment Programs (OTP)
  • Limits the use of an audio-only interactive telecommunications system for mental health services where the beneficiary is not capable of using, or does not consent to, the use of two-way, audio/video technology.
  • CMS is also soliciting comment on:
    • Whether additional documentation should be required in the patient’s medical record to support the clinical appropriateness of the audio-only visit
    • Whether or not we should preclude audio-only telehealth for high-level services, such as level 4 or 5
    • Any additional guardrails

Evaluation and Management Visits: Refinement to current policies for split (or shared) E/M visits, critical care services, and services furnished by teaching physicians involving residents.

Split (or shared) E/M Visits: Defines split (or shared) visits as E/M visits provided in a facility setting by a physician and an NPP in the same group. The practitioner who provides the substantive portion of the visit (more than half of the total time spent) would bill for the visit.

Teaching Physicians: Clarifies that the time when the teaching physician was present can be included when determining E/M visit level. Under the primary care exception specifically, only MDM would be used to select the visit level.

Electronic Prescribing of Controlled Substances: Creates exceptions to the requirement for electronic prescribing of controlled substances as well as proposing to extend the start date for compliance actions to January 1, 2023.

Appropriate Use Criteria (AUC) Program: Proposes initiating payment penalty 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. The extended date is intended to take into consideration the impact that the PHE for COVID-10 has had on providers and beneficiaries.

Medicare Shared Savings Program: Recommends a longer transition for the Accountable Care Organizations (ACOs) reporting electronic clinical quality measure/Merit Based Incentive Payment System (MIPS) all payer quality measures under the Alternative Payment Model Performance Pathway. Proposing to extend the collection of data through the CMS Web Interface for an additional two years, through performance year 2023.


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