CY 2023 Medicare Physician Fee Schedule Proposed Rule

On 7th July 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2023. This calendar year (CY) 2023 PFS proposed rule made lots of provisions including expanding Medicare telehealth use even after the end of a public health emergency (PHE).

Expanding Medicare Telehealth Use after PHE

For the calendar year 2023, CMS is proposing a number of policies related to Medicare telehealth services including making several services that are temporarily available as telehealth services for the PHE available through CY 2023 on a Category III basis, which will allow more time for collection of data that could support their eventual inclusion as permanent additions to the Medicare telehealth services list. CMS is proposing to extend the duration of time that services are temporarily included on the telehealth services list during the PHE, but are not included on a Category I, II, or III bases for a period of 151 days following the end of the PHE, in alignment with the Consolidated Appropriations Act, 2022 (CAA, 2022).

CMS is proposing to implement the telehealth provisions in the CAA, 2022 via program instruction or other sub-regulatory guidance to ensure a smooth transition after the end of the PHE. These policies extend certain flexibilities in place during the PHE for 151 days after the PHE ends, such as 

• allowing telehealth services to be furnished in any geographic area and in any originating site setting, including the beneficiary’s home, 
• allowing certain services to be furnished via audio-only telecommunications systems, and 
• allowing physical therapists, occupational therapists, speech-language pathologists, and audiologists to furnish telehealth services. 

The CAA, 2022 also delays the in-person visit requirements for mental health services furnished via telehealth until 152 days after the end of the PHE. We are proposing that telehealth claims will require the appropriate place of service (POS) indicator to be included on the claim, rather than modifier “95,” after a period of 151 days following the end of the PHE and that modifier “93” will be available to indicate that a Medicare telehealth service was furnished via audio-only technology, where appropriate.

Increased Use of Medicare Telehealth During PHE

To reduce COVID-19 exposure in health care environments, the Centers for Medicare & Medicaid Services (CMS) authorized waivers in March 2020 that expanded telehealth services for Medicare beneficiaries. These waivers allowed for telehealth in-home visits, services in urban areas, and audio-only interaction for some services. The US Department of Health and Human Services (HHS) report noted that in 2020, a greater proportion of beneficiaries in urban than rural areas used telehealth services. Among clinicians, behavioral health specialists had the highest increase in telehealth visits. In 2019, only 1 percent of visits to behavioral health specialists were telehealth; in 2020, the percentage jumped to 38.1 percent. By the end of 2020, telehealth visits to behavioral specialists were as common as in-person visits. 

You can refer to “Calendar Year (CY) 2023 Medicare Physician Fee Schedule Proposed Rule” for detailed information. MedicalBillersandCoders (MBC) is a leading revenue cycle company providing complete medical billing services. We can assist you in receiving accurate insurance reimbursement for delivered services. To know more about our medical billing and coding services, Contact us at info@medicalbillersandcoders.com / 888-357-3226