On July 13, 2023, the Centers for Medicare and Medicaid Services (CMS) released the public inspection version of the CY 2024 Medicare Physician Fee Schedule (MPFS) Proposed Rule. This proposed rule puts forth proposed Medicare Part B reimbursement updates expected to be effective on 01/01/2024. The
proposed rule is scheduled to be published to the Federal Register on 08/07/2023. Comments are due by 09/11/2023.
Below is a general summary of issues of particular relevance to therapy services. It is important to note thatat this time, no associated changes in practices for therapy service provision, coding, or billing are required. The federal rule-making process requires that the proposed changes and updates be affirmed by a final rule in order to be implemented.
Topic Area: MPFS Conversion Factor
Key Points in the Proposed Rule:
- The proposed CY 2024 PFS conversion factor is $32.7476.
- This proposed update is a decrease of $1.14, or approximately 3.34%, from the CY2023 MPFS conversion factor of $33.8872.
- The proposed decrease includes a 1.25% decrease due to factors specified in law, together with offsetting and budget neutrality adjustments attributable to CMS’ proposed increases in payment for primary care and other types of direct patient care.
- CMS noted that by law, the Geographic Practice Cost Indices (GPCIs) 1.0 work floor expires on December 31, 2023, and as such has provided addenda files that show the expected impact.
Topic Area: KX Modifier Threshold
Key Points in the Proposed Rule:
- Based on the most recent 4.5% estimate of an update to the Medicare Economic Index for CY 2024, CMS is proposing updates to the Medicare Part B KX Modifier thresholds to$2,330 for Physical Therapy (PT) and Speech-Language Pathology (SLP) combined and$2,330 for Occupational Therapy (OT).
- The Medical Review Thresholds for PT and SLP combined and for OT remain at $3,000through CY 2027.
Topic Area: Telehealth Services
Key Points in the Proposed Rule:
- To align with the Consolidated Appropriations Act of 2023 provision that extends Medicare coverage of therapy telehealth services to 12/31/2024, CMS is proposing to continue the temporary allowance for the originating site to be anywhere in the United States, including an individual’s home; to expand of the definition of telehealth practitioners to include qualified occupational therapists, qualified physical therapists, qualified speech-language pathologists; and to extend the coverage and payment of telehealth services included on the Medicare Telehealth Services List (as of 03/15/2020) until 12/31/2024. The assigned telehealth code categories for therapy codes are not proposed to change.
Topic Area: Definition of Direct Supervision for Private and Group Practice
Key Points in the Proposed Rule:
- CMS proposes to continue to define direct supervision to permit the presence and“immediate availability” of the supervising practitioner through real-time audio and visual interactive telecommunications through 12/31/2024.
Topic Area: Remote Therapeutic Monitoring (RTM) Services
Key Points in the Proposed Rule:
- CMS is proposing a regulatory change to allow for general supervision of physical therapist assistants and occupational therapy assistants by PTs and OTs, respectively, in private/group practices for remote therapeutic monitoring (RTM) services.
- CMS puts forth clarifications regarding RTM, referring providers back to the CY 2021MPFS final rule.
Topic Area: Review of Misvalued Codes
Key Points in the Proposed Rule:
- CMS has identified 19 therapy codes that have been nominated as potentially misvalued codes. The reason for reassessment of the values assigned to these “always therapy”codes is that CMS does not believe that the Multiple Procedure Payment Reduction(MPPR) should be applied to these 19 therapy codes’ clinical labor time entries.Nomination of the codes is a beginning step in possible revaluation of the codes and will likely not result in any changes in CY 2024.
Topic Area: New Caregiver Training Codes
Key Points in the Proposed Rule:
- CMS is proposing to add and implement payment for three new “sometimes therapy” codes that will be used to report face-to-face time spent providing caregiver training in strategies and techniques to facilitate a patient’s functional performance in the home or community(e.g., activities of daily living [ADLs], instrumental ADLs [IADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) without the patient present. CPT Code 9X015 is proposed for the initial 30 minutes of individual training with9X016 as a 15-minute add-on code. 9X017 is proposed for group training to caregivers of patients
In addition, CMS is soliciting comment regarding:
- The effectiveness of telehealth services by institutional providers when furnished remotely, compared to in-person.
- Whether to revise the current private/group practice regulatory policy for direct supervision of physical therapist assistants and occupational therapy assistants by PTs and OTs to a general supervision policy for all services, not just for RTM services; CMS noted particular interested in receiving comments, including any available supporting data, on the potential effects of implementing such a policy, including but not limited to patient quality of care, patient safety, and changes in utilization.
- Remote physiologic monitoring (RPM) and RTM proposals and clarifications, as well as general feedback from the public that may be useful in further development of CMS payment policies for remote monitoring services that are separately payable under the current PFS.
The voluminous proposed rule also includes several other topic areas, such as:
- CMS proposals for new codes for community integration services, for Principal Illness Navigation services to help patients navigate treatment for cancer and other serious illnesses, and for social determinants of health assessments
- CMS proposal regarding payment for certain dental services prior to and during several different cancer treatments
- CMS proposals to add health and well-being coaching services to the Medicare Telehealth Services List on a temporary basis for CY 2024, and Social Determinants of Health RiskAssessments on a permanent basi.
- Refinement of policies to allow implementation of an add-on code for evaluation and management visits for primary care and longitudinal care of complex patients
- Changes in enrollment rules to allow marriage and family therapists, mental health counselors, including addiction counselors, to enroll in Medicare and bill for their services
- Medicare Shared Savings Program,Quality Payment Program, and Accountable Care Organization (ACO) updates
- Merit-based Incentive Payment System (MIPS) updates
- Payment policies for Rural Health Clinics and Federally Qualified Health Clinics
Additional Resources:
- Federal Register webpage for the proposed rule: 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; Continued Implementation
of Requirements for Manufacturers of Certain Single-dose Container or Single-use Package Drugs
to Provide Refunds with Respect to Discarded Amounts; Medicare Advantage; Medicare and
Medicaid Provider and Supplier Enrollment Policies; and Basic Health Program - CMS webpage with related proposed rule fee schedule files for CY 2024
- CMS MPFS Proposed Rule Press Release
- CMS MPFS Proposed Rule Fact Sheet
- CMS Quality Payment Program (QPP) Fact Sheet (PDF version)
- CMS Medicare Shared Savings Program (MSSP) Fact sheet
- CMS PFS webpage
If you have questions or need additional information, please contact the Powerback Rehabilitation and Powerback Respiratory email inquiry system at askregulatory@powerbackrehab.com.
