The Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates Physician Fee Schedule (PFS) payments for Calendar Year (CY) 2024. The rule includes policies that reduce the payment update, extend certain telehealth flexibilities, advance health equity and update the Medicare Shared Savings Program (MSSP) and the Quality Payment Program (QPP). These policies take effect on January 1st. For an in-depth summary, click here.

Payment Update

CMS proposes to cut the conversion factor by 3.4%, from $33.89 in CY 2023 to $32.74 in CY 2024. There is currently a Senate bill that includes a 1.25% increase in the Medicare PFS, which would result in a payment cut of 2.15%  instead of 3.4%. While there is no certainty of the bill passing, the inclusion of this policy in the Senate’s bill to fund the government beyond November 17th is a good sign as the previous package didn’t include anything to address the physician payment cuts.

Changes to Medicare Telehealth

  • Medicare Telehealth Services List: CMS finalized its proposal to add the new SDOH screening code to the list of eligible telehealth services on a category I (permanent) basis. It also will add health and well-being coaching services on a temporary basis.
  • Telehealth Flexibilities: CMS will extend certain flexibilities until Dec. 31, 2024, including expanding eligible provider types to include qualified occupational therapists, physical therapists, speech-language pathologists and audiologists; allowing certain services to be furnished via audio-only telecommunications systems and allowing payment for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) furnishing telehealth services. Most importantly, CMS will continue to reimburse telehealth services provided at the patient’s home (POS 10) at the higher, PFS non-facility rate until Dec. 31, 2024. Unfortunately, claims billed with POS 02 (Telehealth Provided Other than in Patient’s Home) will continue to be paid at the lower PFS facility rate.
  • Direct Supervision: The rule extends the definition of direct supervision to include virtual presence via audio/video real-time communications technology through CY 2024. CMS also will allow virtual supervision of residents when the service is performed virtually across teaching settings (both Metropolitan Service Areas and Non-Metropolitan Service Areas) through CY 2024.

Behavioral Health

CMS finalized several policies to increase access to behavioral health.

  • For the first time, Medicare T Part B will provide payment for the services of Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs).
  • CMS will allow addiction counselors who meet all the applicable requirements to be an MHC to enroll in Medicare as MHCs.
  • CMS created new HCPCS codes under the PFS for psychotherapy for crisis services and will allow the Health Behavior Assessment and Intervention services described by CPT codes 96156, 96158, 96159, 96164, 96165, 96167 and 96168, and any successor codes, to be billed by clinical social workers, MFTs and MHCs, in addition to clinical psychologists.

Quality Payment Program

As mandated by MACRA, the QPP includes two tracks — the traditional Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).

  • MIPS Value Pathways (MVPs): In prior rulemaking, CMS adopted a framework for MVPs that the Agency intended as a long-term replacement for the current MIPS. In this rule, CMS adopts five additional MVPs that will be available for the CY 2024 performance period: women’s health; ear, nose and throat disorders; prevention and treatment of infectious disorders; mental health and substance use disorders; and rehabilitative support for musculoskeletal care.
  • Advanced APM Bonus Payments: CMS will offer APM Incentive Payments in CY 2025 to qualifying clinicians. This one-year extension of Advanced APM bonus payments at a reduced rate of 3.5% is required by the CAA.

Other Takeaways

  • Withdraws all regulations related to the Appropriate Use Criteria (AUC) program.
  • Revises the definition of the “substantive portion” of a split (or shared) visit to be more than half of the total time spent by the physician and non-physician practitioner. performing the split (or shared) visit or a substantive part of the medical decision-making.