Highlights from the Proposed Physician Fee Schedule for 2023 – Part 2

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The Centers for Medicare and Medicaid Services (CMS) released the 2023 Proposed Physician Fee Schedule in early July, with the comment period being open until Tuesday, Sept. 6, 2022. Physicians and practice leaders are encouraged to comment as CMS will address each comment in the Final Rule, expected in November or December this year.

Some of the highlights where comments should be considered include:

Telehealth
There are currently three categories of telehealth CPT codes. Before the Public Health Emergency (PHE) telehealth CPT codes were separated into two categories:

  1. Category 1: This is assigned to services that are similar to professional consultations, office visits, and office psychiatry services that are currently on the list of approved telehealth services
  2. Category 2: This is assigned to services that are not similar to any service on the Category 1 current list of telehealth covered services.

For fiscal year 2021, CMS wanted to add a third, temporary category due to COVID-19. A fairly long list of CPT codes was added to the list of covered telehealth services and these CPT codes will be covered until the end of the year in which the public health emergency expires.

In the Proposed Rule, CMS will extend the coverage for all services, included on a temporary basis, for 151 days post-PHE, including those codes added this past March, after the Consolidated Appropriations Act, 2021. CMS is proposing that some codes will be removed from the list of telehealth codes at Day 152 (see list in Table 10), as opposed to the end of the year in which the PHE expires as previously announced. If your practice is billing through Day 151, you will be required to report the Place of Service (POS) code where that service would have been reported if furnished face-to-face. Then starting Day 152, CMS will discontinue modifier 95 and require you to report POS 02 (telehealth provided other than patient’s home) or POS 10 (in patient’s home).

In the data seen by the practices using InfoDive®, the team is seeing a decrease in the use of telehealth since the pandemic started.

Since HHS publicly communicated they would provide a 60-day notice if they were not going to extend the PHE, it appears the PHE set to expire on October 13, 2022 will be extended until the middle of January 2023. Practices are urged to comment on the codes under Category 3 if they make a difference to your practice, asking that they become part of the permanent set of codes under Categories 1 and 2.

Miscellaneous items to consider
Discarded drugs: Requires drug manufacturers to refund CMS for certain discarded amounts from refundable single-dose containers or single-use package drugs (Medicare Part B). CMS will have to report any discarded medication recorded above a 10 percent low-volume threshold. Certain drugs will be excluded – like imaging agents or drugs new (less than 18 months) to Medicare Part B reimbursement.

CMS is proposing that starting next year, a separate JZ modifier be used to denote NO discarded amounts. Practices will continue to use the JW modifier indicating waste as well as the JZ modifier indicating no waste. In preparation for this new JZ modifier practices should review workflow, automation and how data enters its MAR and EMR. If practices are concerned about the additional burden of placing a modifier on every drug billed to Medicare Part B, they should consider commenting on this specific proposal (pages 491-501 in the Proposed Rule).

Global Surgical Valuation: Practices using these codes should look at page 58 of the Proposed Rule. CMS is looking for comments as they believe they are overpaying for visits not being utilized during the global surgical packages.

Dental services: CMS is considering paying for dental services, especially when it precedes organ transplant. Practices who provide cancer treatment or perform joint replacement surgery should also consider commenting if they consider this a benefit to their patients. Look at Page 435 of the Proposed Rule.

Colorectal cancer screening: CMS is proposing lowering the age for screening from 50 years to 45, but also is considering covering a follow-up colonoscopy when needed, as a preventive service. See Page 576 for the proposal.

Other issues being considered include: Appropriate Use Criteria (penalty phase will not start in 2023 according to CMS website); Virtual Services (no proposals for transitional care management, chronic care management or remote physiologic monitoring, although a reduction in RPM reimbursement was proposed); Remote Therapeutic Monitoring (RTM – replacing current treatment management codes and clarifying billing rules) and Chronic Pain Management (page 705 – bundling the management and treatment services, that are in addition to visit codes).

The InfoDive team has been supporting practices with powerful business intelligence that can help with approaches to coding, productivity, revenue collection, and more. The team presents informational webinars monthly to help practices understand how their data can help their financial health, especially during the everchanging reimbursement landscape. Their most recent webinar on the 2023 Medicare PFS Proposed Rule can be found at: https://globalmeetwebinar.webcasts.com/starthere.jsp?ei=1561110&tp_key=34dd6066c0.

For answers to your questions regarding any of the information presented, contact InfoDiveSupport@intrinsiq.com.