Top Six Takeaways from the Proposed 2023 Medicare Physician Fee Schedule: New Remote Monitoring, Behavioral Health, and Chronic Pain Care Management Codes and Telehealth Flexibility Extension
The much-anticipated 2023 Medicare Physician Fee Schedule Proposed Rule (“2023 Proposed Rule”) from the Centers for Medicare & Medicaid Services (“CMS”) has arrived! Despite a slight reduction in reimbursement amounts across the board, the rule includes new reimbursement opportunities for managing the care of behavioral health and chronic pain patients, along with much-needed fixes to the Remote Therapeutic Monitoring (“RTM”) codes introduced last year. More detailed analyses from the Nixon Gwilt Law team will follow, but in the meantime, here are our top takeaways from the 2023 Proposed Rule.
Improvements to the Remote Therapeutic Monitoring codes
Last year’s Physician Fee Schedule introduced five new CPT codes for RTM aimed at improving therapy adherence and response for patients. While the new codes were a step in the right direction, the code structures themselves were problematic, limiting the ability of clinical staff to assist in monitoring therapeutic data and communicating with patients unless directly supervised by a billing practitioner.
On behalf of our clients and alongside key stakeholder organizations, we advocated for changes to the RTM code set that included replacing two of the codes with new codes that would allow clinical staff to monitor and manage patient care under the general supervision of the billing physician or non-physician practitioner (“NPP”) and reimburse for the supply of any medical device (as opposed to just respiratory or musculoskeletal devices) used for monitoring. In the 2023 Proposed Rule, CMS responded by creating four new HCPCS G codes to increase patient access to RTM and reduce the supervisory burden on physicians/NPPs by allowing incident to billing of auxiliary staff under general supervision, while asking for additional comments on any new coding related to the supply of RTM devices. We’ll consider this a win for now, and we look forward to responding to CMS’s request for comments on RTM devices.
New Cognitive Behavioral Therapy Monitoring code
We have long posited that remote monitoring of patients undergoing behavioral health therapy will result in better outcomes for these patients, and we are pleased to see that the American Medical Association’s CPT Committee and CMS are beginning to show signs that they agree. The CPT Committee adopted a new code for the initial setup and supply of a Cognitive Behavioral Therapy device, which could presumably be used in conjunction with the RTM monitoring/care management codes. Interestingly, CMS has decided to allow each regional Medicare Administrative Contractor (“MAC”) to price this code while they “learn more about the devices being used to furnish this service.”
More “Incident to” Behavioral Health Services
In another victory for patients in need of mental health services, CMS will allow these behavioral health services to be furnished by auxiliary staff under the “general supervision” of a physician or NPP – meaning that staff need not be physically present in the same place as the supervising physician/NPP – citing the “increased need for behavioral health treatment and workforce shortages in this field.” To further address this shortage, CMS has also created a new HCPCS G-code allowing Clinical Psychologists or Clinical Social Workers to provide care management services for behavioral health conditions.
New Chronic Pain Management codes
CMS has also responded to the call for reimbursement of care management services specifically targeted at patients experiencing chronic pain, defined as “persistent or recurrent pain lasting longer than three months.” The 2023 Proposed Rule calls for two new G codes for chronic pain management and treatment by a physician or “other qualified health care professional” during a calendar month. While these new codes would not allow services to be provided “incident to” the billing practitioner, CMS specifically requests comments on this point, including whether they could be provided under “general supervision.”
No news is not good news for Remote Physiologic Monitoring
We were disappointed to see that CMS has once again remained silent in response to loud calls from the remote monitoring industry for changes to its interpretation of requirements for billing the Remote Physiologic Monitoring (“RPM”) code set. In the 2021 Medicare Physician Fee Schedule, CMS indicated that 16 days of readings of patient-generated health data must be transmitted by a connected device in order to bill the CPT codes for setup/patient education (CPT Code 99453) and supply of the device(s) (CPT Code 99454). Stakeholders rightfully point out that this requirement is contraindicated for certain conditions and imposes a barrier to the adoption/utilization of this important care management service.
Congress still needs to act on Telehealth
As you may recall, extending reimbursement for telehealth services provided at a patient’s home beyond the current Public Health Emergency (“PHE”) requires an act of Congress. CMS is doing what it can to expand access, however, by proposing additional services to the list of telehealth services that will remain in effect for 151 days after the expiration of the PHE. In addition, CMS is proposing to extend other PHE-related waivers and exceptions for the 151-day period beginning on the first day after the end of the PHE. These include (1) the temporary expansion in the scope of telehealth originating sites to include any site in the United States where the beneficiary is located at the time of the telehealth service, including an individual's home; (2) the temporary expansion of eligible telehealth practitioners to include audiologists and OT/ST/PT practitioners; (3) the temporary telehealth payment policies for RHCs and FQHCs; (4) delay of the in-person requirements for audio-only telemental health services; and (5) the temporary coverage of certain telehealth services provided via audio-only during the PHE.
Of note is CMS’ request for comments on what types of services could be provided under direct supervision with virtual availability of the supervising practitioner. Much real estate in the 2023 Proposed Rule is devoted to preparing providers for the eventual end of the PHE, and how this will impact billing and reimbursement, which clearly signals that the end is near if Congress doesn’t set up and take action.
Stay tuned as we take a deeper dive into each of these areas over the coming days, and contact us if you would like assistance understanding these changes and/or submitting comments to CMS.