2024 Medicare Provider Fee Schedule Proposed Rule Highlights

Last Updated: Aug 9, 2023

The Centers for Medicare and Medicaid Services has released the calendar year 2024 Medicare Physician Fee Schedule (MPFS) proposed rule. As PAMED continues to review the proposed rule, we will provide a more comprehensive interpretation for our members.  

Conversion Factor

In December 2022, President Biden signed the 2023 Consolidated Appropriations Act which extended some flexibilities toward Telehealth, though promised a cut in the Conversion Factor for the 2024 MPFS. The proposed rule predicts a 3.36 percent reduction in the 2024 Medicare conversion factor, lowering it from $33.8872 to $32.7476.

Medicare Provider and Supplier Enrollment

Under the 2024 MPFS, CMS is proposing to add a new Medicare Provider Enrollment status of “stay of enrollment” which would serve as a preliminary interim status prior to any deactivation or revocation and pause enrollment which would prevent placing a hold on any sanction or adverse action of the Medicare enrollment. The provider/supplier must be non-compliant with one enrollment requirement and the provider/supplier completes the applicable change or revalidation application to remedy their situation (CMS, 2023).

Along with this new status, CMS is proposing to require all Medicare provider and supplier types to report any modifications to their practice locations within 30 days of the event occurring. To continue with changes to the Medicare Provider and Supplier Enrollment, CMS is proposing to establish new and revised Medicare denial and revocation authorities. And as a final proposal to the Medicare Provider and Supplier Enrollment, they are proposing to cap the length of time for which a Medicaid provider will remain in the MTD (Medicaid Termination Database) which would be 10 years (CMS, 2023).

Telehealth

CMS is implementing the telehealth flexibilities previously included in the Consolidated Appropriations Act 2023 (CAA) by waiving the geographic and originating site requirements for Medicare telehealth services through the end of CY 2024. Patients will retain the ability to access telehealth services from their own homes.  For 2024, CMS is further proposing to continue paying for telehealth services provided to patients in their homes at the same rate as in-person visits and allow direct supervision to be provided virtually.

Prior to the COVID-19 pandemic, there were regulatory safeguards that prevented full-service telehealth services for Diabetes Self-Management Training. Given the changes in clinical standards and guidelines, regarding the use of telehealth, CMS is proposing to eliminate the regulatory safeguards as the hope is that this will increase access and awareness to DSMT services which are demonstrating results in improving the care of individuals with diabetes. Another added benefit is that CMS is proposing to provide payment for DSMT along with two other services Medical Nutrition Therapy and Outpatient Therapy until the end of 2024 (CMS, 2023).

Another addition that is proposed for Telehealth Services under the 2024 MPFS is to add health and well-being coaching services to the Medicare Telehealth Services list on a temporary basis for 2024 and the services of SDOH Risk Assessments to be added permanently (CMS, 2023).

Opioid Treatment Program

According to the 2024 MPFS proposed rule, CMS is suggesting an extension of the current flexibilities that are allowing providers to furnish periodic assessments by way of audio-only telecommunications through the end of 2024 if video is not available for the beneficiary. This extension of flexibilities is proposed to align with the 2023 Consolidated Appropriations Act’s telehealth flexibilities for OTPs and to promote access and minimize barriers to care since the PHE has ended (CMS, 2023).

Evaluation and Management Visits

The Centers for Medicare and Medicaid Services is proposing in their 2024 MPFS to implement separate payment for HCPCS code G2211 which is an add-on code that can assist in the acknowledgment of resource costs connected to E/M visits for primary care and longitudinal care of complex patients. They are also proposing that this code is not used when a modifier is needed that involves an office and outpatient E/M visit that is unbundled from another service.

Additionally, CMS is proposing a continued delay in the implementation of substantive portion of Split (or Shared) E/M visits as more than half of the total time at least through CY 2024. In concession, CMS is proposing to maintain the current definition of the substantive portion for CY 2024 when being used for History, Exams, Medical Decision-Making, or more than half of the total time spent to determine who bills the visit (CMS, 2023).

Behavioral Health Services

For CY 2024, CMS is implementing Section 4121 of the CAA, 2023, providing coverage and payment under Medicare Part B for the services of Marriage and Family Therapists (MFT) and Mental Health Counselors (MHCs) when billed by these professionals. Under the MHC definition, CMS is proposing to allow for addiction counselors that meet the applicable requirements of an MHC to have the capability of enrolling in Medicare as an MHC. CMS is also proposing to make changes to Behavioral Health Integration codes to allow these professionals to provide integrated behavioral health care in primary care settings (CMS, 2023).

As required in the CAA, 2023, CMS is required to establish new HCPCS codes regarding psychotherapy for crisis services furnished in an applicable site of service on or after January 1, 2024. Payment for these psychotherapy for crisis services shall be equal to 150% of the fee schedule amount for non-facility sites of services 90839 (Psychotherapy for crisis; first 60 minutes), and 90840 (Psychotherapy for crisis; each additional 30 minutes – List separately in addition to code for primary service) and any succeeding codes (CMS, 2023).

In continued proposals regarding behavioral health services, CMS is proposing to allow the Health Behavior Assessment and Intervention (HBAI) services to be billed by CSWs, MFTs, and MHCs in addition to clinical psychologists. The services are described by the following CPT codes:  

  • 96156, 96158,96159
  • 96164, 96165, 96167, 96168

Appropriate Use Criteria

CMS is proposing to rescind the current AUC program regulations as well as pause implementation efforts. CMS will continue efforts to identify a workable implementation plan and announce developments through future rulemaking (CMS, 2023).

Merit-based Incentive Payment System (MIPS)

CMS is proposing to increase the performance threshold to avoid a MIPS penalty from 75 to 82 points. Bonuses and penalties from the 2024 performance period would apply to payments in 2026 (CMS QPP, 2023).

CMS is proposing five new MIPS Value Pathways (MVPs) for addition to the 2024 performance year, along with some revisions to the previously finalized MVPs (CMS QPP, 2023). The newly proposed are as follows:

  1. Focusing on Women’s Health
  2. Quality Care for the Treatment of Ear, Nose, and Throat Disorders
  3. Prevention and Treatment of Infectious Disorders including Hepatitis C and HIV
  4. Quality Care in Mental Health and Substance Use Disorders
  5. Rehabilitative Support for Musculoskeletal Care

CMS is proposing to increase the performance period for the Promoting Interoperability (PI) Category to a minimum of any continuous 180-day period within CY 2024 (CMS QPP, 2023). Currently the performance period is a minimum of 90 continuous days within the calendar year.

MIPS Promoting Interoperability and Shared Savings CEHRT update

CMS is updating the Shared Savings program’s CEHRT requirements by aligning their requirements with that of the Quality Payment Program’s Promoting Interoperability (CMS, 2023). This alignment is being made due to the QPP’s Promoting Interoperability CEHRT requirements being more comprehensive, also addressing key functions that can facilitate better care coordination and quality measurement and improvement than the Shared Savings Program requirements (CMS, 2023).  Given this alignment, CMS is proposing to remove the CEHRT threshold requirement for the Shared Savings Program and reward a MIPS category score to those who meet the measurements when reporting Promoting Interoperability measures to MIPS (CMS, 2023).

AMA’s “Fix Medicare Now” Campaign

In the 2023 House of Delegates, the AMA adopted a new policy to start a Campaign that would work toward promoting physician payment reform specifically the Medicare Physician payment system in alignment with AMA policy and in concert with the principles endorsed by 120 state and medical specialty Federation of Medicine members, including PAMED (O’Reilly, 2023). A bill has been introduced in Congress to provide annual inflation updates to the MPFS based on the MEI (Medicare Economic Index). The bill is a bipartisan bill known as HR 2474 – Strengthening Medicare Patient and Providers Act and was last referred to the Subcommittee on Health. The AMA created a website to help educate those who are interested in contributing an effort toward the campaign. The website is https://fixmedicarenow.org/ (AMA, 2023).

References:

  1. Centers for Medicare and Medicaid Services (CMS). (2023, July 13). Fact sheet calendar year (CY) 2024 Medicare physician fee schedule proposed rule. Centers for Medicare and Medicaid Services (CMS) https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-proposed-rule
  2. Centers for Medicare and Medicaid Services (CMS). Medicare and Medicaid Programs; CY 2024 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Advantage; Medicare and Medicaid Provider and Supplier Enrollment Policies; and Basic Health Program. 88 Fed Reg. 14624 (July 13, 2023) (to be codified at 42 C.F.R. pts. 405,410,411,414,415,418,422,423,424,425,455,489,491,495,498, and 600) https://public-inspection.federalregister.gov/2023-14624.pdf
  3. AMA CY 2024 Medicare Physician Payment Schedule and Quality Payment Program (QPP) Proposed Rule Summary. https://www.ama-assn.org/system/files/ama-summary-2024-mfs-proposed-rule.pdf
  4. Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP). (2023, July 12). Calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS) Notice of Proposed Rule Making - Quality Payment Program Policy Overview: Proposals and Requests for Information  . 2024 QPP Proposed Rule Fact Sheet and Policy Comparison Table. https://www.cms.gov/files/document/2024-qpp-proposed-rule-fact-sheet-and-policy-comparison-table.pdf
  5. Centers for Medicare and Medicaid Services (CMS). (2023, July 13). Fact sheet calendar year (CY) 2024 Medicare physician fee schedule proposed rule - medicare shared savings program proposals. Centers for Medicare and Medicaid Services (CMS). https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-proposed-rule-medicare-shared-savings-program
  6. O’Reilly, K. B. (2023, June 12). Fixing medicare physician pay system a top priority for the AMA. American Medical Association. https://www.ama-assn.org/practice-management/medicare-medicaid/fixing-medicare-physician-pay-system-top-priority-ama
  7. AMA. (2023, June 12). Homepage: Fix medicare now. Homepage | Fix Medicare Now. https://fixmedicarenow.org/

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