On November 2, CMS the Centers for Medicare and Medicaid Services (CMS) finalized its calendar year (CY) 2022 updates to the Medicare Physician Fee Schedule (PFS). Most notably in the final rule, CMS announced it will extend Medicare reimbursement to physicians for certain telehealth services through the end of 2023. The rule also includes several provisions that aim to expand flexibility for telehealth reimbursement for mental health. CMS had expanded flexibility for providers to get Medicare reimbursement for telehealth at the onset of the COVID-19 pandemic. But the flexibility only lasts through the public health emergency, which was extended through early 2022.
Final Rule
“Promoting health equity, ensuring more people have access to comprehensive care, and providing innovative solutions to address our health system challenges are at the core of what we do at CMS,” said CMS Administrator Chiquita Brooks-LaSure. “The Physician Fee Schedule final rule advances all these strategic priorities and helps build a better Medicare program for the future.”
Telehealth
Many key policy changes were finalized in the rule, especially around telehealth. The Consolidated Appropriations Act of 2021 (CAA) removed geographic site restrictions for individuals with mental health disorders. CMS is finalizing this requirement as well as a CAA provision which stipulates that—for the diagnosis, evaluation, or treatment of mental health disorders—there must be an in-person, non-telehealth service with the physician or practitioner within six months prior to the initial telehealth service. Additionally, the final rule requires the Secretary to establish a frequency for subsequent in-person visits.
CMS will also retain certain services added on a temporary basis in response to the COVID-19 public health emergency (PHE) to the Medicare telehealth services list until the end of CY 2023. CMS has indicated that the goal of this policy is to allow the agency to collect more information on utilization during the pandemic and to give stakeholders an opportunity to submit requests for the permanent addition of appropriate services to the telehealth list.
Furthermore, CMS is amending its definition of an “interactive telecommunications system” for telehealth services. CMS codified its proposal to include audio-only communication technology when used for telehealth services for the diagnosis, evaluation, or treatment of mental health disorders furnished to established patients in their homes. However, the agency is limiting the use of audio-only telehealth services furnished by providers who have the ability to provide two-way audio and video communications but choose audio-only communications due to beneficiary choice or limitations due to broadband access.
E/M Visits
CMS finalized several policies related to updating coding and payment for E/M visits, including policies related to a visit that is split or shared by both a physician and a nonphysician nurse practitioner (NPP). CMS revised the definition of split/shared visit to include only E/M visits provided in the facility setting by a physician and an NPP in the same group. Further, the final rule establishes that the visit is billed by the physician or practitioner who provides the substantive portion of the visit. CMS also codified its proposal to modify its existing policy to allow for split/shared visits for both new and established patients and for critical care and certain skilled nursing facility/nursing facility visits. With regard to teaching physician services, the agency finalized, and clarified that, when time is used to select the office/outpatient E/M visit level, only the time spent by the teaching physician in qualifying activities can be included for purposes of visit level selection.
ASP Drug Price Reporting
CMS is finalizing regulatory changes to implement the CAA’s requirement that manufacturers of drugs or biologicals payable under Part B without a Medicaid Drug Rebate Agreement report ASP data. Starting with calendar quarters beginning on January 1, 2022, manufacturers will be required to report ASP for drugs and biologicals payable under Medicare Part B. CMS amended the definition of “drug” to include an item, service, supply, or product that is payable under Medicare Part B as a drug or biological. CMS notes that it is not persuaded to exempt re-packagers from the new reporting requirements, but that it may propose to exempt them in the future, if warranted.
Open Payments
CMS finalized as proposed several changes to the program, including: (1) the addition of a mandatory payment context field for records to teaching hospitals; (2) the option to recertify annually, including when no records are being reported; and (3) no longer allowing record deletions without a substantiated reason, among other provisions.