ACTION: Notice. The FY 2022 budget proposes $131.8billion in discretionary budget authority and $1.5 trillion in mandatory funding. Start Preamble AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. Payments are based on the relative resources typically used to furnish the service. Ambulatory Surgical Center Dental, Federally Qualified Health Center Dental, General Dental, and Rural Health Center Dental fee schedules prior to Nov. 3, including archives, are available at the links below.Please follow these steps to look up the plan's maximum allowable for many . Effective July 1, 2022 - For dates of service on/after July 1, 2022, processed on or after July 5, 2022 (CMS Change Request 12773) Note . %%EOF . The pandemic has highlighted the importance of access to COVID-19 vaccines, as well as access to other preventive vaccines. SUMMARY: This notice announces a $688.00 calendar year (CY) 2023 application fee for institutional providers that are initially enrolling in the Medicare or Medicaid program or the Children's Health Insurance Program (CHIP); revalidating their Medicare, Medicaid, or CHIP enrollment; or adding a new . This proposal will simplify communication about compliance between reporting entities and CMS. This general record for ownership is separate from ownership and investment interest, which is its own type of record. Oct 5 3. Considering the increased needs for mental health services and feedback we have received, we are finalizing our proposal to create a new General BHI code describing a service personally performed by CPs or clinical social workers (CSWs) to account for monthly care integration where the mental health services furnished by a CP or CSW are serving as the focal point of care integration. ( In addition to cases where one remaining unit of a multi-unit therapy service to be billed, this revision to the policy would apply in a limited number of cases where more than one unit of therapy, with a total time of 24-28 minutes is being furnished. CMS is proposing to implement section 132 of the CAA, which makes FQHCs and RHCs eligible to receive payment for hospice attending physician services when provided by a FQHC/RHC physician, nurse practitioner, or physician assistant who is employed or working under contract for an FQHC or RHC, but is not employed by a hospice program, starting January 1, 2022. Finalizing the use of the 2017-based MEI cost weights to set PFS rates would not change overall spending on PFS services, but would result in significant distributional changes to payments among PFS services across specialties and geographies. CMS is also finalizing the proposal to allow a psychiatric diagnostic evaluation to serve as the initiating visit for the new general BHI service. 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. CMS is finalizing exclusions to this definition as required by statute for drugs that are either radiopharmaceuticals or imaging agents, drugs that require filtration during the drug preparation process, and drugs approved on or after the date of enactment of the Infrastructure Act (that is, November 15, 2021) for which payment under Part B has been made for fewer than 18 months. Orthodox Christmas Day 2022. We are proposing to remove the requirement that the medical nutrition therapy referral be made by the treating physician and update the glomerular filtration rate (GFR) to reflect current medical practice. Secure .gov websites use HTTPSA For drugs with unique circumstances, CMS solicited comment on whether an increased applicable percentage would be appropriate for drug that is reconstituted with a hydrogel and administered via ureteral catheter or nephrostomy tube into the kidneys; in this circumstance, there is substantial amount of reconstituted hydrogel that adheres to the vial wall during preparation and not able to be extracted from the vial for administration. Beginning January 1, 2022, PAs would be able to bill Medicare directly for their services and reassign payment for their services. When both the PTA/OTA and the PT/OT each furnish less than eight minutes for the final 15-minute unit of a billing scenario. Customer Support will be closed from 9:30 am - 12 pm CT on the second and fourth . For most services furnished in a physicians office, Medicare makes payment to physicians and other professionals at a single rate based on the full range of resources involved in furnishing the service. CMS is proposing to require that OTPs use a service-level modifier for audio-only services billed using the counseling and therapy add-on code and document in the medical record the rationale for a service being furnished using audio-only services, in order to facilitate program integrity activities. Payment due to Plan. You need nursing home care. Laboratory Fee Schedule - Jan. 1, 2022 - PDF. We are also proposing to extend the compliance deadline for, Part D prescriptions written for beneficiaries in, Section 405 of the CAA also requires that beginning July 1, 2021, the ASP-based payment limit for billing codes. https:// From 1 January 2022, patient access to telehealth services will be supported by continued MBS arrangements. However, we believe it would be beneficial to create system efficiencies related to the reconciliation and invoicing system of the discarded drug refunds and the new inflation rebate programs under the Inflation Reduction Act, and so we are not finalizing the timing of the initial report to manufacturers or date by which the first refund payments are due. CMS finalized the proposal to annually update the payment amount for vaccine administration services based upon the increase in the MEI, and to adjust for the geographic locality based upon the geographic adjustment factor (GAF) for the PFS locality in which the preventive vaccine is administered. Some examples include reconstruction of the jaw following fracture or injury, tooth extractions done in preparation for radiation treatment for cancer involving the jaw, or oral exams preceding kidney transplantation. In the CY 2022 PFS proposed rule we are proposing: The AMA CPT office/outpatient E/M visit coding framework that CMS finalized for CY 2021, under which practitioners can select the office/outpatient E/M visit level to bill, was based either on use of the total time personally spent by the reporting practitioner or medical decision making (MDM). However, we are soliciting comment on whether the original date of January 1, 2022, should remain, in light of the proposed exceptions to the mandate. Under our existing regulations, if a resident participates in a service furnished in a teaching setting, a teaching physician can bill for the service only if they are present for the key or critical portion of the service. Over the last several years, Medicare payment rates for physicians and mass immunizers for administering certain preventive vaccines (flu, pneumonia and hepatitis B vaccines) have decreased by roughly 30%. CMS is proposing to make conforming technical changes to the regulatory text related to COVID-19 vaccines for RHCs and FQHCs. Specifically, we are finalizing revisions to 414.507(d) to indicate that for CY 2022, payment may not be reduced by more than 0% as compared to the amount established for CY 2021, and for CYs 2023 through 2025, payment may not be reduced by more than 15% as compared to the amount established for the preceding year. We finalized the proposed rebasing and revising of the 2017-based MEI with some technical revisions to the proposed method based on public comments. An official website of the United States government. The dates listed under Part D also apply to MA and cost-based plans offering a Part D benefit. For CY 2022, in response to stakeholder concerns about parity with other types of NPPs, we are proposing to establish regulations at 410.72 for their services since they are the only NPP type listed at section 1842(b)(18)(C) of the Act without a regulatory provision in this section of 42 CFR subpart B. We are also proposing to freeze the quality performance standard for PY 2023, by providing an additional one-year before increasing the quality performance standard ACOs must meet to be eligible to share in savings, and additional revisions to the quality performance standard to encourage ACOs to report all-payer measures. .gov A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. That no other E/M visit can be billed for the same patient on the same date as a critical care service when the services are furnished by the same practitioner, or by practitioners in the same specialty and same group to account for overlapping resource costs. In the CY 2022 PFS proposed rule, we are proposing the following: Similarly, we are proposing to refine our longstanding policies for critical care services. Our policies also directly support President Bidens Cancer Moonshot Goal to cut the death rate from cancer by at least 50 percent over the next 25 years and addresses his recent proclamation of March 2022 as National Colorectal Cancer Awareness Month. hbbd```b``+@$Ln`,r~"YwEO0&y$ v;5H[x lN0 = We also included a comment solicitation seeking public input as we develop a more consistent, predictable approach to incorporating new data in setting PFS rates. The AMA provides final rule summary (PDF) of the 2023 Medicare Physician Payment Schedule and Quality Payment Program (QPP). To address this, CMS is proposing language that will clarify the impermissibility of delaying general payments, and that research-related payments do not need to have been specifically outlined in the original research agreement to be reported as research payments. The finalized direct access policy will allow beneficiaries to receive care for non-acute hearing assessments that are unrelated to disequilibrium, hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids. CMS is proposing to begin the payment penalty phase 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. L. 117-9, November 15, 2021) amended section 1847A of the Act adding provisions that require manufacturers to provide a refund to CMS for certain discarded amounts from a refundable single-dose container or single-use package drug. As noted above, the rebased and revised MEI weights were not used in CY 2023 PFS ratesetting. Before sharing sensitive information, make sure youre on a federal government site. You are age 65 or older. The finalized codes include a bundle of services furnished during a month that we believe to be the starting point for holistic chronic pain care, aligned with similar bundled services in Medicare, such as those furnished to people with suspected dementia or substance use disorders. We will take into account the comments we received in response to CY 2023 rulemaking and feedback received in association with the Town Hall in order to strengthen proposed policies for skin substitutes in future rulemaking. With the proposed budget neutrality adjustment to account for changes in RVUs (required by law), and expiration of the 3.75 percent payment increase provided for CY 2021 by the Consolidated Appropriations Act, 2021 (CAA), the proposed CY 2022 PFS conversion factor is $33.58, a decrease of $1.31 from the CY 2021 PFS conversion factor of $34.89. To review the entire final rule, visit the Federal Register. CMS is finalizing that providers will be required to report the JW modifier beginning January 1, 2023 and the JZ modifier no later than July 1, 2023 in all outpatient settings. ACOs accepting performance-based risk must establish a repayment mechanism (i.e, escrow, line of credit, surety bond) to assure CMS that they can repay losses for which they may be liable upon reconciliation. The CAA, 2022 extends certain flexibilities in place during the PHE for 151 days after the PHE ends, including allowing payment for RHCs and FQHCs for furnishing telehealth services as distant site practitioners (though note that mental health visits can be furnished virtually on a permanent basis) under the payment methodology established for the PHE, allowing telehealth services to be furnished in any geographic area and in any originating site setting, including the beneficiarys home, and allowing certain services to be furnished via audio-only telecommunications systems. 596 0 obj <> endobj We are also finalizing payment for dental exams and necessary treatments prior to the treatment for head and neck cancers starting in CY 2024, and finalizing a process in CY 2023 to review and consider public recommendations for Medicare payment for dental service in other potentially analogous clinical scenarios. means youve safely connected to the .gov website. CMS is proposing to add a required field to teaching hospital records to address this issue. Christmas Eve (December 25) Christmas Day (December 26) Training Closure Schedule. Rural Health Clinic (RHC) Payment Limit Per-Visit. . In contrast, PFS rates paid to physicians and other billing practitioners in facility settings, such as a hospital outpatient department (HOPD) or an ASC, reflect only the portion of the resources typically incurred by the practitioner in the course of furnishing the service. CMS is proposing to revise the current regulatory language for RHC or FQHC mental health visits to include visits furnished using interactive, real-time telecommunications technology. We are exploring how these policies interact with the Shared Savings Programs other benchmarking policies. 2022 Holiday Schedule (for 835 and 837 transactions) . For CY 2022, we are proposing to establish regulations at 410.72 for registered dietitians and nutrition professionals, similar to established regulations for other non-physician practitioners. The proposed method for determining the 2017-based MEI relies on estimating base year expenses from publicly available data from the U.S. Census Bureau NAICS 6211 Offices of Physicians. RHCs and FQHCs are not authorized to serve as distant site practitioners for Medicare telehealth services after the end of the COVID-19 public health emergency. CMS is proposing to give companies the option to recertify and attest to the fact that they do not have any records to submit for a reporting year. . SUMMARY: This notice announces a $631.00 calendar year (CY) 2022 application fee for institutional providers that are initially enrolling in the Medicare or Medicaid program or the Children's Health Insurance Program (CHIP); revalidating their Medicare, Medicaid, or CHIP enrollment; or adding a new . This includes resubmitting corrected claims that . While we implemented this change through our usual change request process, we neglected to update this regulation when the Affordable Care Act (ACA) of 2010 amended the statute to except the coinsurance and deductible for preventive services defined under section 1861(ddd)(3) of the Act that have a grade of A or B from the United States Preventive Services Task Force and MNT services received a grade of B. However, we solicited comments on the potential use of the proposed updated MEI cost share weights to calibrate payment rates and update the GPCI under the PFS in the future. CMS is proposing to allow OTPs to furnish counseling and therapy services via audio-only interaction (such as telephone calls) after the conclusion of the COVID-19 PHE in cases where audio/video communication is not available to the beneficiary, including circumstances in which the beneficiary is not capable of or does not consent to the use of devices that permit a two-way audio/video interaction, provided all other applicable requirements are met. CMS proposed to clarify and codify certain aspects of the current Medicare fee-for-services payment policies for dental services. Jan 7 - Fri. We are also finalizing our proposals to codify and clarify various laboratory specimen collection fee policies in 414.523(a)(1). means youve safely connected to the .gov website. Revised interpretive guidelines for levels of medical decision making. April 14 July 4 is a holiday for 12-month employees only This calendar reects the 2022-2023 academic calendar approved by the Board of Education on July 13, 2021. . We are proposing that the changes would be applicable for determining beneficiary assignment beginning with PY 2022. CMS is interested in stakeholder input on what qualifies as the home and how we can balance ensuring program integrity with beneficiary access. We are seeking comment on whether a different interval may be necessary or appropriate for mental health services furnished through audio-only communication technology. Official websites use .govA Contents. The Telehealth Originating Site Facility Fee has been updated for CY 2023, which can be found with the list of Medicare Telehealth List of Services at the following website: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes. We are proposing to amend the beneficiary notification requirement to set forth different notification obligations for ACOs depending on the assignment methodology selected by the ACO to help avoid unnecessary confusion for beneficiaries. We finalized new HCPCS codes, G3002 and G3003, and valuation for chronic pain management and treatment services (CPM) for CY 2023. Also, you can decide how often you want to get updates. For most services furnished in a physicians office, Medicare makes payment to physicians and other professionals at a single rate based on the full range of resources involved in furnishing the service. Medicare currently can only make payment to the employer or independent contractor of a PA. Consequently, PAs could not bill and be paid by the Medicare program directly for their professional services; they also did not have the option to reassign payment for their services or to incorporate with other PAs to bill the program for PA services. Individuals who intend to view and/or listen to the meeting do not need to register. lock lock and also establishes the professional qualifications for these practitioners. means youve safely connected to the .gov website. Medicare Manuals. As future dates for 2022 are announced, we will update the calendar. Holiday & training closures. Secure .gov websites use HTTPSA Holiday Name Calendar Date Legal Banking Holiday Observed Date BCBSIL Holiday Observed Date* New Year's Day 2022 . Requiring reporting of a modifier on the claim to help ensure program integrity. We observe most federal holidays, as well as select additional corporate holidays. Further, section 1814(i)(6) of the Act, as added by section 3132(a)(1)(B) of the PPACA, authorized . As proposed, CMS will base the payment amount for the drug component of HCPCS codes G2067 and G2078 for CY 2023 and subsequent years on the payment amount for methadone in CY 2021 and update this amount annually to account for inflation using the PPI for Pharmaceuticals for Human Use (Prescription). This often leads to disputes, a process by which the covered recipient initiates a conversation with the reporting entity to get more information, creating work for both parties. Chronic Pain Management and Treatment Services. website belongs to an official government organization in the United States. The calendar is available in the Downloads section in both a color and plain text format and identifies the following dates: Sign up to get the latest information about your choice of CMS topics. d 3 We finalized the proposal to allow physicians and practitioners to continue to bill with the place of service (POS) indicator that would have been reported had the service been furnished in-person. You can decide how often to receive updates. Requiring Manufacturers of Certain Single-Dose Container or Single-Use Package Drugs to Provide Refunds with Respect to Discarded Amounts. Additionally, after consideration of public comments and further analysis, we are finalizing an increase to the nominal fee for specimen collection based on the Consumer Price Index for all Urban Consumers (CPI-U). CMS also proposed and sought comment on payment for other dental services that were inextricably linked to, and substantially related and integral to, the clinical success of, an otherwise covered medical service, such as dental exams and necessary treatments prior to organ transplants, cardiac valve replacements, and valvuloplasty procedures. or Since the requirements for the chronic pain management and behavioral health integration services are similar to the requirements for the general care management services furnished by RHCs and FQHCs (which are the current services for which RHCs and FQHCs can use HCPCS code G0511) the payment rate for HCPCS code G0511 will continue to be the average of the national non-facility PFS payment rates for the RHC and FQHC care management and general behavioral health codes (CPT codes 99484, 99487, 99490, and 99491) and PCM codes (CPT codes 99424 and 99425) Payment will be updated annually based on the PFS amounts for these codes, which is how these updates are made currently. Split (or shared) visits could be reported for new as well as established patients, and initial and subsequent visits, as well as prolonged services.
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