The federal Centers for Medicare and Medicaid Services (CMS) on August 3 issued the
proposed Physician Fee Schedule for 2021. The rule proposes a $3.83 reduction in the PFS conversion factor for CY 2021. Additionally, the rule proposes several changes to Medicare telehealth coverage. Category 1 services, which are similar to existing services, are updated in the rule.
Importantly, CMS proposes to create a third temporary category of criteria for adding services to the list of Medicare telehealth services. Category 3 describes services added to the Medicare telehealth list during the public health emergency (PHE) for the COVID-19 pandemic that will remain on the list through the calendar year in which the PHE ends. These include services like home visits for the evaluation and management (E/M) of an established patient with problems of higher severity than those allowed under Category 1, as well as emergency department E/M visits for a patient.
CMS is not proposing to continue to recognize audio-only payment codes under the PFS in the absence of the PHE for the COVID-19 pandemic; however, it acknowledges that the need for audio-only interactions could remain as beneficiaries continue to try to avoid sources of potential infection. Therefore, CMS is seeking comments on whether CMS should develop coding and payment for a service similar to the virtual check-in but for a longer unit of time and subsequently with a higher value. CMS is also seeking comments on whether this should be a provisional policy to remain in effect until a year after the end of the PHE for the COVID-19 pandemic or if it should be a permanent PFS payment policy.
The Remote Patient Monitoring (RPM) services that were added during the COVID-19 pandemic are modified in the proposed rule. CMS is proposing to return to the requirement that an established patient-physician relationship exist for RPM services to be furnished. Several other RPM clarifications are also proposed in the rule.
For purposes of limiting exposure during the duration of the PHE for COVID-19, CMS adopted an interim final policy revising the definition of “direct supervision” to include virtual presence of the supervising physician or practitioner using interactive audio/video real-time communications technology. CMS is proposing to continue this policy through December 31, 2021 and is seeking comments on whether there should be additional guardrails for the policy during this time, as well as comments on whether the policy should be continued beyond 2021.
Payment for outpatient E/M visits, as finalized in the CY 2020 PFS final rule, will largely be aligned with rule changes laid out by the CPT Editorial Panel for office/outpatient E/M visits, beginning January 1, 2021.
The proposed rule contains several proposals regarding professional scope of practice, including making permanent a COVID-19 policy that allowed nurse practitioners, clinical nurse specialists, physician assistants and certified nurse-midwives (CNMs) to supervise the performance of diagnostic tests in addition to physicians. The rule also proposes to allow physical and occupational therapists to use the same discretion to delegate maintenance therapy services to PT and OT assistants that they utilize for rehabilitative services.
The rule also contains provisions to implement year five of the Quality Payment Program (QPP) created under MACRA.
WHA will seek input on the rule from WHA members before submitting comments to CMS, which are due October 5. For more information contact WHA Vice President for Policy Development
Laura Rose.