Orthopedic Coding Alert

Rules on SDoH, telehealth highlight proposal.

Even though the COVID-19 public health emergency (PHE) is in the rearview mirror, its ghost remains in the details of the CY 2024 Medicare Physician Fee Schedule (MPFS).

Background: The Centers for Medicare & Medicaid Services (CMS) released the proposed rule July 13. CMS is offering updates on several post-PHE issues, offering policy fixes for next year. The proposed rule was published in the Federal Register on August 7.

Here are five MPFS proposals you should keep an eye on:

1. Solidify CAA, 2023, telehealth policies through December 31, 2024. CMS plans to implement the Consolidated Appropriations Act, 2023 (CAA, 2023) telehealth services provisions through the end of 2024. This includes allowing the patient’s home as an originating site and lifting geographic restrictions; letting Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) provide telehealth services; adding four specialist-types to the approved provider list; extending audio-only telehealth service coverage and payment; and delaying the in-person behavioral health visit requirement.

2. Place of service (POS) will determine telehealth services rate. CMS proposes to pay telehealth services furnished in a patient’s home — POS 10 (Telehealth provided in patient’s home) — at the higher, non-facility PFS rate, indicates a fact sheet on the rule. POS 2 (Telehealth provided other than in patient’s home) will remain as is paid at the facility rate.

3. Equity and SDoH are front and center in the proposals. “Building on CMS’ goal of increasing health equity, the agency has proposed coding and payment for several new services to help underserved communities,” summarizes Miranda Franco, senior policy advisor with law firm Holland & Knight LLP, in an H & K Health Dose blog post. “These include certain caregiver training programs, separate coding and payment for community health integration services, payment for principal illness navigation services, and coding and payment for social determinants of health risk assessments,” Franco expounds.

4. Split/shared policy gets pushed out further. CMS intends to keep the current split/ shared rules for a little bit longer, opting for another delay, with a start date now slated for Jan. 1, 2025. CMS finalized implementing its split/shared policy that the provider who administers the substantive portion of the visit bills for the E/M services — whether it’s the physician or the nonphysician practitioner (NPP) — in the CY 2022 MPFS final rule and then delayed it once already in the CY 2023 MPFS final rule.

Heads up: If you want to offer your two cents on these or other policies, you have until September 11 to weigh in.

Resource: Check out the MPFS proposals and instructions on commenting at https:// public-inspection.federalregister.gov/2023-14624.pdf.