The Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates and policy changes for Medicare payments under the calendar year (CY) 2023 Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2023.
Here’s what you need to know:
- The final CY 2023 PFS conversion factor is $33.06, a decrease of $1.55 to the CY 2022 PFS conversion factor of $34.61.
- Similar to the CY 2021 PFS final rule approach for office/outpatient E/M visit coding and documentation, CMS finalized and adopted most of these AMA CPT changes in coding and documentation for Other E/M visits (which include hospital inpatient, hospital observation, emergency department, nursing facility, home or residence services, and cognitive impairment assessment) effective January 1, 2023.
- CMS determined which professional should bill for a shared visit by defining the “substantive portion,” of the service as more than half of the total time. 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.
- CMS finalized its proposal to extend the duration of time that services are temporarily included on the telehealth services list during the PHE for at least a period of 151 days following the end of the PHE, in alignment with the Consolidated Appropriations Act, 2022 (CAA, 2022).
- 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 licensed professional counselors (LPCs) and Licensed Marriage and Family Therapists (LMFTs), incident to the services of a physician (or NPP).
- Finalized new HCPCS codes, G3002 and G3003, and valuation for chronic pain management and treatment services (CPM) for CY 2023
- In order to stabilize the price for methadone for CY 2023 and subsequent years, CMS is finalizing the proposal to revise its methodology for pricing the drug component of the methadone weekly bundle and the add-on code for take-home supplies of methadone.
- CMS finalized a policy to allow beneficiaries direct access to an audiologist without an order from a physician or NPP for non-acute hearing conditions.
- 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.
- For CY 2023, CMS is finalizing two updates to expand the Medicare coverage policies for colorectal cancer screening in order to align with recent United States Preventive Services Task Force and professional society recommendations.
- 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.
- The final CY 2023 Medicare Economic Index (MEI) update is 3.8 percent based on the most recent historical data available.
- CMS is finalizing the addition of chronic pain management and behavioral health integration services to the RHC and FQHC specific general care management HCPCS code, G0511, which aligns with changes made under the PFS for CY 2023.
Source: U.S. Centers for Medicare & Medicaid Services (CMS)
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