The Centers for Medicare & Medicaid Services (CMS) issued the CY 2024 Physician Fee Schedule (PFS) final rule that announces policy changes for Medicare payments under the PFS and other Medicare Part B payment policy issues. This final rule became effective on January 1, 2024.
The 2024 PFS introduces essential changes and updates crucial for healthcare providers to ensure compliance and maintain financial viability.
According to the CMS, the calendar year (CY) 2024 PFS final rule is one of several final rules that reflect a broader Administration-wide strategy to create a more equitable healthcare system that results in better access to care, quality, affordability, and innovation.
Key Highlights of the CMS CY 2024 Physician Fee Schedule:
Rate setting and conversion factor
Payment rates under the PFS will be reduced by 1.25% in CY 2024 compared to CY 2023. In addition, CMS is finalizing increases in payment for primary care and other kinds of direct patient care.
Also, the final CY 2024 PFS conversion factor is $32.74, a reduction of $1.15 (or 3.4%) from the current CY 2023 conversion factor of $33.89.
Caregiver training services
CMS is finalizing a proposal to make payment when practitioners train caregivers to support patients with specific diseases or illnesses in a treatment plan.
Medicare will pay for these services when they are delivered by a physician, a non-physician practitioner, or a therapist as part of the patient’s individualized treatment plan or therapy plan of care.
CMS services addressing health-related social needs
For CY 2024, CMS is finalizing payment and coding changes to better account for resources involved in furnishing patient-centered care involving a multidisciplinary team of clinical staff and other auxiliary personnel.
CMS has finalized decisions to pay separately for the following services:
- Community Health Integration (CHI)
- Social Determinants of Health (SDOH) Risk Assessment
- Principal Illness Navigation (PIN)
The services described by the finalized codes are the first specifically designed to describe services involving community health workers, care navigators, and peer support specialists.
Evaluation and Management (E/M) visits
CMS is completing the implementation of a separate add-on payment for healthcare common procedure coding system (HCPCS) code G2211. Implementing payment for this add-on code has redistributive impacts for all other CY 2024 payments under the Medicare PFS.
In the context of split (or shared) E/M visits, CMS is finalizing a revision to its definition of “substantive portion” of a shared visit to include modifications to the Current Procedural Terminology (CPT) guidelines.
CMS telehealth services
CMS is finalizing a proposal to add health and well-being coaching services temporarily to the Medicare Telehealth Services List (TSL) for CY 2024, with SDOH being a permanent inclusion.
Regarding telehealth, CMS is also focusing on:
- Refinements to the process to analyze requests received for the addition of services to the Medicare TSL
- Implementation of several telehealth-related provisions of the Consolidated Appropriations Act, 2023
- Payments at the non-facility PFS rate for telehealth services furnished to people in their homes
- The direct supervision definition to allow the presence and immediate availability of the supervising practitioner through real-time audio and video interactive telecommunications through December 31, 2024.
- Telehealth services furnished in teaching settings
Medicare Part B payment for preventive vaccine administration services
CMS is finalizing a proposal to maintain the additional payment for in-home COVID-19 vaccine administration and extend this payment to administering the pneumococcal, influenza, and hepatitis B vaccines when provided at home.
Therefore, effective January 1, 2024, Medicare Part B will pay the same additional payment amount to providers and suppliers that administer a pneumococcal, influenza, hepatitis B, or COVID-19 vaccine in the home.
CMS behavioral health services
CMS is also finalizing:
- Implementation of Section 4121 of the CAA, 2023, which providers for Medicare Part B coverage and payment under the Medicare PFS for the services of marriage and family therapists (MFTs) and mental health counselors (MHCs) when billed by these professionals.
- Implementation of Section 4123 of the CAA, 2023, which requires the Secretary to establish new HCPCS codes under the PFS for psychotherapy for crisis services furnished in an applicable site of service.
- Proposal to allow the Health Behavior Assessment and Intervention (HBAI) services described by specific CPT codes.
- An increase in the valuation for timed behavioral health services under the PFS.
Ambulance Fee Schedule (AFS)
Section 4103 of the CAA, 2023, extended three temporary add-on payments to the ground ambulance base and mileage rates under the AFS through December 31, 2024.
CMS is completing a proposal to revise their regulations at 42 CFR §414.610(c)(1)(ii) and 414.610(c)(5)(ii) in the current final rule to align with existing law.
Additional Changes in the CMS CY 2024 Final Rule include:
- Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
- Telehealth proposals for DSMT services
- Opioid treatment programs (OTPs)
- Expanded diabetes screening
- Dental and oral health services
- Appropriate use criteria (AUC) for Advanced Diagnostic Imaging Program
- Medicare and Medicaid provider and supplier enrollment
Read the CY 2024 Medicare Physician Fee Schedule Final Rule Fact Sheet for more information.
Learn more about these updates and how to optimize your payments for the New Year. Feel free to reach us at [email protected]. Our team will set up a meeting to discuss how Health Prime can maximize your revenue by cutting costs, saving time, and collecting more!
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