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More coverage of the proposed PFS: Vaccine pricing, policy updates and more

08/14/2023

Don’t miss out on yet more policy changes contained in the proposed 2024 Medicare physician fee schedule, from vaccine payments to the never-used Appropriate Use criteria and more. Get all the latest here:

E/M fee preview: Care management service tops list with 26% pay jump

08/14/2023

by: Richard Scott and Laura Evans, CPC

A number of services in the E/M category are on track for big pay gains in CY 2024, led by behavioral health care management (99484), set for a 26% jump to $54 per service, and joined by two prolonged services codes (99415, 99416).

First payable code shows virtual reality’s advance, as other pay models await

08/07/2023

by: Roy Edroso

There’s a lot of talk about virtual reality (VR) in health care, despite the lack of direct reimbursement for its use from payers. Experts say there are current opportunities for VR as an added benefit in some health care settings, and plenty of developmental activity that’s promising for the future. But for most providers, both the patient benefits and the payments may be years away.

Cultivate Medicare prolonged service rule compliance with a decision tree

08/07/2023

by: Julia Kyles, CPC

Use this decision tree to illustrate Medicare’s rules for coding prolonged E/M services. Medicare created codes and rules for prolonged services performed by a physician or qualified health care professional (QHP) because it disagrees with portions of the CPT guidelines.

To boost diabetes program, CMS revamps code set, extends virtual options

08/07/2023

by: Richard Scott

Due to billing confusion, low utilization rates and patient retention challenges, CMS seeks to deliver a sleeker design behind the Medicare Diabetes Prevention Program (MDPP) in 2024. The agency plans to chop the number of HCPCS codes eligible for reporting while maintaining virtual options for patient encounters, according to the proposed 2024 Medicare physician fee schedule released July 13.

CMS to kick 19 therapy codes back to the RUC for review

08/07/2023

by: Laura Evans, CPC

In a potential windfall for therapy practices, CMS stated in the proposed 2024 Medicare physician fee schedule, released July 13, that it would consider revaluing 19 therapy codes to evaluate whether they had been misvalued during their last review five years ago.

Determine key tips for reporting SDOH in ICD-10-CM

08/07/2023

by: Savannah Schmidt

Question: What are some tips for organizations that are just starting out capturing the type of information to report social determinant of health (SDOH) diagnoses in ICD-10-CM?

Remote BPCI codes, E/M services big gainers in proposed PFS fee dollars

08/07/2023

by: Roy Edroso; data reporting by Laura Evans, CPC

Among the services for which CMS proposes to raise reimbursement by the largest percentage in CY 2024, there’s a thread of E/M codes that meet two of CMS’ recent areas of focus – remote services and bundled care.

CMS lays plans for new telehealth list structure, code update policy

07/31/2023

by: Julia Kyles, CPC

Take note of Medicare’s plan to revamp the telehealth services list and the way it makes additions, revisions and deletions to the subset of eligible codes.

CMS locks in CAA 2023 telehealth waivers

07/31/2023

by: Julia Kyles, CPC

Practices can rest assured that Medicare will implement the waiver extensions in the Consolidated Appropriations Act, 2023. The extension keeps waivers such as the originating site, the list of eligible providers and coverage of audio-only services in place until Jan. 1, 2025, says Rachel Stauffer, senior director, McDermott+Consulting, Washington, D.C.

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