Regulatory Update Roundup: Summarize recent changes in coding guidelines, regulations, or payer policies.
I came across an article by CMS called Medicare Physician Fee Schedule Final Rule, effective January 1, 2024. I highlighted some of the changes that were mentioned in the article.
There are new codes added to Medicare Telehealth Services. The CPT codes 0591T to 0593T are for health and well being coaching services, which are added on a temporary basis. HCPCS code G0136 is for Social Determinants of Health Risk Assessment, and it has been added on permanent basis.
There is a temporary expansion of the scope of telehealth to include any site in the U.S. This is in regards to where the patient is at the time of the telehealth service, including the patient's home. Services provided at the patient's home will be paid at non-facility PFS rate. Modifier 95 should be used when the provider is at the hospital and the patient is at home. This also applies to outpatient therapy services provided via telehealth by PT, OT, or SLP.
Definition of telehealth practitioners now includes occupational therapists (OT), physical therapists(PT), speech language pathologists (SLP) and audiologists.
Frequency limitation has been removed for subsequent inpatient visits, subsequent nursing facility visits and critical care consultation.
The telehealth origination site facility fee payment update - Medicare Economic Index has increased by 4.6% for 2024.
Office Outpatient G2211 code is now separately payable, because CMS is now recognizing that separately identifiable visits do occur on the same day as minor procedures, and there is a significant cost difference between the two visits. But it will not be payable when you add modifier 25 to it.
Behavior Health Services - Addiction counselors who meet the applicable requirements will be able to enroll as MHC and to be able to bill Medicare for services.
Dental and Oral Health - Medicare is permitting payment for certain medically necessary dental services that are linked to other covered services, such as chemotherapy services, chimeric antigen receptor-T (CAR-T) cell therapy, and the use of high dose bone modifying agents (antiresorptive therapy).
Therapy services - no longer need direct supervision, general supervision is allowed for therapy assistants by PTPPs and OTPPs for remote therapeutic monitoring services.
DSMT services provided by Registered Dietitians or nutrition professional must personally perform the services themselves . RD or nutrition professional may bill on behalf of the DSMT entity, regardless of who provided the services.
CHI services - separate payment and codes for CHI services, which include community health workers who help underserved communities with critical health care and social services.
PIN services & SDOH - new codes and payments for PIN services, HCPCS codes G0023, G0024, G0140 and G0146, for auxiliary personnel such as patient navigators and peer support specialists to provide navigation in the treatment of a serious high risk condition or illness. SDOH risk assessment must include housing insecurity, food insecurity, transportation needs, and utility difficulty. New codes and payments for SDOH risk assessments G0136, must be provided together with qualifying visit such as E/M visit, some behavioral visit or annual wellness visit.
Caregiver Training - New CPT codes 96202, 96203, 97550, 97551 and 97552, payments will be made when the practitioners train and involve one or more caregivers to assist patients with certain diseases or illnesses in carrying out a treatment plan. The services has to be provided by a physician or a NP, CNS, certified nurse midwives, PA and clinical psychologists, or therapist (PT, OT or SLP) under an individualized treatment plan or therapy plan of care, without the patient present.
I came across an article by CMS called Medicare Physician Fee Schedule Final Rule, effective January 1, 2024. I highlighted some of the changes that were mentioned in the article.
There are new codes added to Medicare Telehealth Services. The CPT codes 0591T to 0593T are for health and well being coaching services, which are added on a temporary basis. HCPCS code G0136 is for Social Determinants of Health Risk Assessment, and it has been added on permanent basis.
There is a temporary expansion of the scope of telehealth to include any site in the U.S. This is in regards to where the patient is at the time of the telehealth service, including the patient's home. Services provided at the patient's home will be paid at non-facility PFS rate. Modifier 95 should be used when the provider is at the hospital and the patient is at home. This also applies to outpatient therapy services provided via telehealth by PT, OT, or SLP.
Definition of telehealth practitioners now includes occupational therapists (OT), physical therapists(PT), speech language pathologists (SLP) and audiologists.
Frequency limitation has been removed for subsequent inpatient visits, subsequent nursing facility visits and critical care consultation.
The telehealth origination site facility fee payment update - Medicare Economic Index has increased by 4.6% for 2024.
Office Outpatient G2211 code is now separately payable, because CMS is now recognizing that separately identifiable visits do occur on the same day as minor procedures, and there is a significant cost difference between the two visits. But it will not be payable when you add modifier 25 to it.
Behavior Health Services - Addiction counselors who meet the applicable requirements will be able to enroll as MHC and to be able to bill Medicare for services.
Dental and Oral Health - Medicare is permitting payment for certain medically necessary dental services that are linked to other covered services, such as chemotherapy services, chimeric antigen receptor-T (CAR-T) cell therapy, and the use of high dose bone modifying agents (antiresorptive therapy).
Therapy services - no longer need direct supervision, general supervision is allowed for therapy assistants by PTPPs and OTPPs for remote therapeutic monitoring services.
DSMT services provided by Registered Dietitians or nutrition professional must personally perform the services themselves . RD or nutrition professional may bill on behalf of the DSMT entity, regardless of who provided the services.
CHI services - separate payment and codes for CHI services, which include community health workers who help underserved communities with critical health care and social services.
PIN services & SDOH - new codes and payments for PIN services, HCPCS codes G0023, G0024, G0140 and G0146, for auxiliary personnel such as patient navigators and peer support specialists to provide navigation in the treatment of a serious high risk condition or illness. SDOH risk assessment must include housing insecurity, food insecurity, transportation needs, and utility difficulty. New codes and payments for SDOH risk assessments G0136, must be provided together with qualifying visit such as E/M visit, some behavioral visit or annual wellness visit.
Caregiver Training - New CPT codes 96202, 96203, 97550, 97551 and 97552, payments will be made when the practitioners train and involve one or more caregivers to assist patients with certain diseases or illnesses in carrying out a treatment plan. The services has to be provided by a physician or a NP, CNS, certified nurse midwives, PA and clinical psychologists, or therapist (PT, OT or SLP) under an individualized treatment plan or therapy plan of care, without the patient present.