Medicare Episode Calendar 2023

Medicare Episode Calendar 2023 – Home / Reactions, letters, press releases / Main provisions in the field of telehealth in calendar year 2023 Final reimbursement schedule for doctors

On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) released the final line for the Calendar Year (CY) 2023 Physician Fee Schedule (PFS). The rule updates payment fees and finalizes policy changes effective January 1, 2023. See press release, factsheet, factsheet (MSSP), and final rule.

CMS completed its proposal to add certain services to the Medicare Telehealth List of Category 3-based services by the end of 2023, some of which were not previously added to the Medicare Telehealth List during PGO, but will be added in a articles of association. base.

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In addition, CMS finalized its proposal that Medicare telehealth services delivered on or before the 151st day after the end of PGO will continue to be processed for payment as Medicare in accordance with the telehealth-related flexibility extensions in CAA, 2022. telehealth claims when associated with modifier “95”. CMS also finalized its proposal that physicians and healthcare professionals may continue to report the place of service code that would have been reported if the service had been provided in person during the 151-day period following the end of PBL, as interim finalized on March 31 IFC.

CMS found that none of the requests received before the Feb. 10 filing deadline met the Category 1 or Category 2 criteria for permanent addition to the list of Medicare telehealth services. As a reminder, Category 1 are services similar to professional consultations, office visits, and office psychiatry services currently on the Medicare Telehealth Services List, and the criteria for adding services under Category 2 is that there is evidence of clinical benefit. if offered as telehealth.

CMS also evaluated the appropriateness of the proposed addition of services to the list of Medicare Telehealth Services on a Category 3 basis. CMS has not proposed any changes to the duration of services temporarily included in Category 3. Category 3 will remain included through the end of CY 2023 In the event that the public health emergency extends into CY 2023, CMS may consider reviewing this policy.

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After reviewing public comments, CMS is finalizing the proposed addition of CPT codes 90901, 97150, 97530, 97537, 97542, 97763, and 98960-98962 to the list of Medicare Telehealth Services based on Category 20 C3Y. believes that their proposal, consistent with the changes made by the provisions of the CAA, 2022, to temporarily extend the period that these services will be available on the Medicare Telehealth Services List for PHE to 151 days after the end of PBL, will further increase opportunities to collect information on the experiences of physicians providing telehealth services during PBL for COVID-19. This also helps CMS determine which services ultimately qualify for permanent addition based on Category 1 or Category 2 criteria. CMS encourages stakeholders to use this longer period of time to collect data on service usage, i.e. beyond supportive statements and beyond subjective validations of clinical benefit, supporting their potential addition to future regulatory action.

CMS has not finalized its proposal to keep telephone E/M services on the Medicare Telehealth Services List after the end of the PGO and the 151-day period following the PHE renewal. CMS believes that the statute requires telehealth services to be so analogous to in-person care that the telehealth service is essentially a substitute for a face-to-face meeting. CMS does not believe that, outside of the ALP environment, telephone E/M services would be analogous to in-person care; nor would they be a substitute for a face-to-face meeting. While CMS recognizes that audio-only technology can be used to provide in-home mental health care to patients under certain circumstances after PBL is complete, two-way audio-video communication technology remains the appropriate standard that will apply to Medicare. telecare after PBL and the grace period of 151 days. At the end of PGO and the 151-day extension period provided by CAA, 2022, the only Medicare telehealth services allowed to be provided using audio-only technology will be mental health telehealth services. When a practitioner provides such an E/M service using audio-only technology, he would be charged for the same service as if the service had been provided in person. As such, it is not necessary to add phone-only E/M codes to the Medicare Telehealth Services List for this purpose.

CMS has not finalized its proposal to add the services of Gastrointestinal Tract Imaging, CPT Code 91110, and Ambulatory Continuous Glucose Monitoring, CPT Code 95251, to the list of Category 3-based Medicare Telehealth Services. describe services that are a substitute for an in-person visit, and services that are not essentially face-to-face services are not services that can be provided as Medicare telehealth services.

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CMS completed its proposal to add CPT codes 95970, 95983, and 95984 to the Category 3-based Medicare Telehealth Services List. Medicare claims data suggests these services are delivered through telehealth, and CMS believes there is some potential clinical benefit is for these services when provided through telehealth; however, sufficient evidence is not yet available to consider the services for permanent addition to the Medicare Telehealth Services List under Category 1 or Category 2 criteria.

CMS finalized its proposal to keep emotional/behavioural evaluation, psychological or neuropsychological testing and evaluation services on the list of Medicare Telehealth Services on a Category 3 basis. CMS believes that more time may be needed to develop evidence supporting the decision to Adding services may support permanent support on the Medicare Telehealth Services List based on Category 1 or Category 2.

CMS finalized its proposal to add a number of services to the list on a Category 3 basis that are now temporarily on the Medicare Telehealth Services List during PBL. These services will be included in the Medicare Telehealth Services List through 2023 so that we can evaluate data that may support their permanent addition to the list on a Category 1 or Category 2 basis.

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CMS finalized its proposal to add remote audiology testing services to the list of Category 3-based Medicare Telehealth Services, which would make these services available through telehealth by the end of CY 2023.

CMS completed its proposal to create HCPCS codes G0316, G0317, G0318 in the Category 1 based Medicare Telehealth Services List. These codes will replace existing codes describing extended services, specifically extended hospital services, CPT codes 99356 and 99357.

Services proposed for delisting of Medicare Telehealth Services after 151 days of PBL completion

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As noted in the CY 2022 PFS Final Rule (86 FR 65054), upon termination of PHE for COVID-19, associated waivers and temporary policies will expire, payment for Medicare telehealth services will again be limited by the requirements of Sec. 1834(m) of the Act and CMS will revert to the policies established through the regular notice and comment process through which CMS created the Medicare Telehealth Services List.

CMS completed its proposal to continue to include services on the Medicare Telehealth Services List that are currently listed for delisting when PGO ends (i.e., not currently added to the list based on Category 1, 2 or 3). 151 days after completion of PGO.

CMS completed policies to implement the provisions of section 1834(m) of the Act (including the amendments made by CAA, 2021) and the provisions of CAA, 2022 that extend certain Medicare flexibility for telehealth approved during PGO for 151 days after the end of PBL, including location of origin, type of practitioner, in-person visitation requirements for mental health, and other comprehensive authority in Congress.

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Day after the end of PGO, in accordance with the expansions of health-related flexibility in the CAA, 2022, will continue to be processed for payment such as Medicare telehealth claims when accompanied by modifier “95”. Practitioners will continue to bill with modifier 95 along with the POS code corresponding to the location where the service would have been rendered in person until the end of the year the PBL ends or CY 2023.

CMS completed its proposal that beginning January 1, 2023, a physician or other qualified health care provider who bills for telehealth services delivered with audio-only communications technology must add CPT modifier “93” to claims for Medicare telehealth (for those services that require the use of audio-only technology is permitted under § 410.78(a)(3)), to identify them as being provided using audio-only technology. CMS believes that using modifier “93”, a CPT modifier, will simplify billing as this modifier is used by non-Medicare payers.

CMS is also finalizing its proposal to require all carriers, including RHCs, FQHCs and OTPs, to use modifier “93” when billing eligible mental

Medicare Episode Calendar 2023