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Proposed FY2020 Physician Fee Schedule

Tuesday, July 30, 2019   (0 Comments)
Posted by: TCAA Staff
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Medicare Telehealth Services  - Bundles Payments for Opioid Treatment

  • For CY 2020, we are proposing to add the following codes to the list of telehealth services: HCPCS codes GYYY1, GYYY2, and GYYY3, which describe a bundled episode of care for treatment of opioid use disorders. **

Continued consolidation: Payment for Evaluation and Management (E/M) Services

  • We are proposing to align our E/M coding with changes laid out by the CPT Editorial Panel for office/outpatient E/M visits. The CPT coding changes retain 5 levels of coding for established patients, reduce the number of levels to 4 for office/outpatient E/M visits for new patients, and revise the code definitions. The CPT changes also revise the times and medical decision making process for all of the codes, and requires performance of history and exam only as medically appropriate.
  • We are also proposing to consolidate the Medicare-specific add-on code for office/outpatient E/M visits for primary care and non-procedural specialty care that we finalized in the CY 2019 PFS final rule for implementation in CY 2021 into a single code describing the work associated with visits that are part of ongoing,

Open Payments Program

  • CMS is proposing several changes to Open Payments:
    • 1) expanding the definition of “covered recipient;” (required by SUPPORT Act)  
    • 2); modifying payment categories; and
    • 3) standardizing data on reported medical devices.

Medicare Shared Savings Program

  • CMS is soliciting comment on how to potentially align the Medicare Shared Savings Program quality performance scoring methodology more closely with the Merit-based Incentive Payment System (MIPS) quality performance scoring methodology.
  • In addition, we propose refining the Shared Savings Program measure set by:
    • 1) removing one measure and adding another to the CMS Web Interface, to maintain alignment with proposals under the Quality Payment Program, and
    • 2) reverting one measure to pay-for-reporting due to a substantive change made by the measure owner.

Stark Advisory Opinion Process

  • Last year, CMS issued a Request for Information (RFI) to gather public input on how to address unnecessary burden created by the physician self-referral law, focusing in part on how it may impede care coordination, a key aspect of value-based healthcare.
  • CMS is soliciting comment on potential changes to its advisory opinion process to address these stakeholder comments. Other comments in response to the RFI are expected to be addressed in separate rulemaking.

** Medicare Coverage for Opioid Use Disorder Treatment Services Furnished by Opioid Treatment Programs (OTPs)

Section 2005 of the SUPPORT Act established a new Medicare Part B benefit for opioid use disorder (OUD) treatment services, including medications for medication-assisted treatment (MAT), furnished by opioid treatment programs (OTPs). To meet this statutory requirement, CMS is specifically proposing:

  • Definitions of OTP and OUD treatment services;
  • Enrollment policies for OTPs;
  • Methodology and estimated bundled payment rates for OTPs that vary by the medication used to treat OUD and service intensity, and by full and partial weeks;
  • Adjustments to the bundled payments rates for geography and annual updates;
  • Flexibility to deliver the counseling and therapy services described in the bundled payments via two-way interactive audio-video communication technology as clinically appropriate; and
  • Zero beneficiary copayment for a time limited duration.

CMS intends to implement this benefit beginning January 1, 2020, as required by the SUPPORT Act.


Bundled Payments under the PFS for Substance Use Disorders

  • In the CY 2019 PFS proposed rule, CMS sought comment on creating a bundled episode of care for management and counseling treatment for substance use disorders.
  • CMS is proposing to create new coding and payment for a bundled episode of care for management and counseling for OUD.
  • The new proposed codes describe a monthly bundle of services for the treatment of OUD that includes:
    •  overall management, care coordination, individual and group psychotherapy, and substance use counseling.
    • One code describes the initial month of treatment, which would include administering assessments and developing a treatment plan;
    • another code describes subsequent months of treatment; and
    • an add-on code describes additional counseling.
  • CMS is proposing that the individual psychotherapy, group psychotherapy, and substance use counseling included in these codes could be furnished as Medicare telehealth services using communication technology as clinically appropriate.
  • CMS is also seeking comment on bundles describing services for other SUDs and on the use of MAT in the emergency department setting, including initiation of MAT and the potential for either referral or follow-up care, as well as the potential for administration of long-acting MAT agents in this setting, to help inform whether we should consider proposing to make separate payment for such services in future rulemaking.

Reference the FY2020 Proposed Physician Fee Schedule fact sheet here. 

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