CCHP Takes a Deep Dive Into the CY 2024 PFS Proposals – includes a new fact sheet!

The proposed CY 2024 Physician Fee Schedule (PFS) was released on July 13, 2023. The PFS contains policy changes proposed by the Centers for Medicare and Medicaid Services (CMS) for the Medicare program to take place the following year (unless otherwise stated). Many have been anticipating these proposed rules due to certain temporary telehealth policies currently slated to end this year. The proposed 2024 PFS does provide some clarity around how CMS will address several telehealth policy issues in Medicare for next year, but not all. At this time, these are only proposals. The public has until 5 pm September 11, 2023 to provide comments to CMS regarding these proposed policies.
 
Much of the telehealth related proposals in the PFS focused on updating regulations to reflect changes previously made through legislation, policies set to expire in 2023, or clarifying current policies. Very few new policies were introduced.
 
CMS proposed making necessary regulatory changes to reflect the temporary telehealth policies enacted by the Consolidated Appropriations Act of 2023 (CAA 2023).  These provisions included:

• Temporarily removing the geographic and site requirements for the patient location at the time the telehealth interaction takes place
• Temporarily allowing a more expansive list of eligible providers in Medicare to provide services via telehealth such as physical and occupational therapists and federally qualified health centers (FQHCs) and rural health clinics (RHCs)
• Temporarily allowing some services to continue to be provided via audio-only
• Temporarily suspending the in-person service requirement prior to the delivery of mental and behavioral services via telehealth or audio-only in cases where the geographic requirement does not apply, the service takes place in the home and the patient was not being treated for a substance use disorder

The aforementioned temporary provisions are in effect until December 31, 2024.
 
Some temporary policies that were set to expire at the end of 2023 were also addressed in the PFS. CMS clarified which of the services that are temporarily eligible to be provided via telehealth will continue through 2024. CMS is also proposing a new process for approving and organizing eligible telehealth codes going forward, designating two categories for either “permanent” or “provisional” codes. Additionally, CMS has provided clarity on the use of telehealth when providing “direct supervision” and supervision of residents.  The CY 2024 PFS proposal also extends the waiver on frequency limitations of visits via telehealth in certain institutions, for example skilled nursing facilities, to December 31, 2024.
 
Additionally, through 2024, CMS is proposing to pay practitioners the non-facility rate for services delivered when a patient is at home (billed with place of service (POS) code 10).  In looking at data regarding what and how services were provided during the pandemic, CMS noticed that behavioral health services which would have typically been provided in a health care setting were now often being provided in the patient’s home.  CMS writes,

 
Now that behavioral health telehealth services may be furnished in a patient’s home, which would then serve as an originating site, we believe these behavioral health services are most accurately valued the way they would have been valued without the use of telecommunications technology, namely in an office setting… It appears that practice patterns for many mental health practitioners have evolved, and they are now seeing patients in office settings, as well as via telehealth. As a result, these practitioners continue to maintain their office presence even as a significant proportion of their practice’s utilization may be comprised of telehealth visits. As such, we believe their practice expenses (PEs) are more accurately reflected by the non-facility rate.

 
Based on the above, CMS is proposing for 2024 that claims billed with POS 10 (patient is at home during a telehealth interaction) be paid at the non-facility PFS rate (and this appears to not be restricted just to behavioral health), while claims with POS 02 (telehealth provided in location other than the patient’s home) will be paid the facility rate.  CMS recognized that practitioners using telehealth will likely still have their practice expenses and noted “that there are few differences in PE when behavioral health services are furnished to the patient at home via telehealth as opposed to services furnished in-person.”
 
Other Proposals Included in the PFS: 

• Telephone Evaluation and Management Services – CPT codes 99441-99443 will remain actively priced through 2024 and are considered telehealth services.  CPT codes 98966-98968 are not considered telehealth services but CMS proposes to assign them an active payment status for 2024 “to align with telehealth-related flexibilities that were extended via the CAA, 2023.”
• Originating Site Facility Fee – Will be $29.92 in 2024.
• Telehealth Injection Training for Insulin-Dependent – Propose to allow one hour of in-person training (for initial or follow-up) that is required for insulin-dependent beneficiaries to take place via telehealth.
• Periodic Assessments for Opioid Use Disorder (OUD) by Opioid Treatment Program (OTP) – CMS is proposing to extend allowing audio-only to be used for periodic assessments by OTPs to the end of 2024. The audio-only option will only be available if video is not and to the extent audio-only is permitted by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration (DEA) and all other relevant requirements.
• Telehealth Indicator – CMS is proposing to update how they identify clinicians who provide services via telehealth. Currently, the Indicator uses POS codes 02 or 10 or modifier 95 to identify when a provider used telehealth. The proposal would “use the most recent codes at the time the data are refreshed that identify a clinician as furnishing services via telehealth” as the new way of identifying these providers.  CMS made this proposal to keep current with any changes.

At this point, these are only proposals for which CMS is accepting comments until 5 pm, September 11, 2023.

More information on these and other proposals made can be found in the CY 2024 PFS proposal. CCHP has also prepared a short video and fact sheet on the CY 2024 PFS proposals.