Calendar Year 2023 Proposed Rule
CMS issued the Calendar Year (CY) 2023 Physician Fee Schedule (PFS) proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the PFS and other Medicare Part B payment policy issues. See a summary of key provisions. Proposals include:
- Modernizing coverage for behavioral health services and improving access and quality by allowing licensed professional counselors, marriage and family therapists, and other types of practitioners to bill Medicare under general supervision; allowing psychiatric diagnostic evaluations to serve as the initiating visit for behavioral health integration and paying clinical psychologists and licensed clinical social workers providing integrated behavioral health services as part of a patient’s primary care team; bundling certain chronic pain management and treatment services into new monthly payments; and covering treatment and recovery services from mobile units; read our blog for more information
- Expanding access to Accountable Care Organizations (ACOs) by incorporating advance shared savings payments to certain ACOs; allowing smaller ACOs more time to transition to downside risk; and creating a health equity adjustment to reward excellent care delivered to underserved populations; read our fact sheet for more information
- Adopting CPT changes in coding and documenting other evaluation and management (E/M) visits, including: hospital inpatient, hospital observation, emergency department, nursing facility, home or residence services, and cognitive impairment assessment
- Making several temporarily available telehealth services during the public health emergency (PHE) covered through CY 2023 on a Category 3 basis; extending the time these services are temporarily included on the telehealth services list following the end of the PHE
- Creating a new G-code for audiologists to bill for services without physician referral to allow patients direct access and receive care for non-acute hearing or balance assessments unrelated to hearing aids or examinations for the purpose of prescribing, fitting, or changing hearing aids once every 12 months
- Improving access to colon cancer screening by considering a follow-up colonoscopy to an at-home test a preventive service, and covering it for individuals 45 years of age and above in line with recommendations from the US Preventative Services Task Force
- Expanding the existing policy to include dental services, such as payment for dental examination and treatment preceding a kidney transplant or other organ transplant; and seeking comment on a process to better understand and define when additional dental services may be inextricably linked and integral to the clinical success of other covered medical services
We encourage you to review the rule. The comment period ended on September 6, 2022.
CY 2022 Physician Fee Schedule Update
CMS issued the CY 2022 Medicare Physician Fee Schedule (PFS) final rule that updates payment policies, payment rates, and other provisions for services. See a summary of key provisions, effective on or after January 1, 2022:
- Revises telehealth services under the Consolidated Appropriations Act, 2021; allows use of audio-only communications technology when furnishing mental health services in certain circumstances.
- Finalizes recent changes to Evaluation and Management (E/M) visit codes, such as policies for split (or shared) E/M visits, critical care services, and services furnished by teaching physicians.
- Modifies payment for therapy services furnished in whole or in part by a Physical Therapist Assistant or Occupational Therapy Assistant.
- Updates a payment regulation for Medical Nutrition Therapy services.
- Finalizes considerations for vaccine administration services.
For a one-stop resource focused on new Care Management services under the Physician Fee Schedule, such as chronic care management and transitional care management services, visit the Care Management webpage.
For a one-stop resource focused on Medicare Fee-for-Service (FFS) physicians, visit the Physician Center webpage.
Request for Information- Reducing Scope of Practice Burden (PDF)
Historical MPFSDB Layouts (PDF)
CY 2019 PFS Proposed Rule Documentation Requirements and Payment for Evaluation and Management Visits and Advancing Virtual Care (PDF)
1995 Documentation Guidelines For Evaluation and Management Services (PDF)
Primary Care Incentive Program Payments for 2011 (PDF)
1997 Documentation Guidelines For Evaluation and Management Services (PDF)
Place of Service Codes for Professional Claims (PDF)
Primary Care Incentive Program Payments for 2012 (PDF)
FAQ on Billing G0453 for Remote Intraoperative Neurophysiology Monitoring (PDF)
FAQs for CR 7502: Medicare’s 3-Day Payment Window and the Impacts on Wholly Owned or Wholly Operated Physician Practices (PDF)
Development of A Validation Model for RVUs (PDF)
FAQ for Mammography Services - Updated 1/18/17 (PDF)