CMS releases 2023 proposed Medicare Part B payment updates

The Centers for Medicare & Medicaid Services (CMS) released the proposed Calendar Year (CY) 2023 Medicare Physician Fee Schedule (MPFS) Rule and Fact Sheet on July 7, 2022. These proposed policies would become effective January 1, 2023, if finalized.

Some key highlights with implications for occupational therapy practitioners include:

Conversion Factor

The proposed CY 2023 proposed fee schedule (PFS) conversion factor is $33.08, a decrease of $1.53 from the CY 2022 PFS conversion factor of $34.61. This decrease is due in part to the expiration of the 3% increase in PFS payments for CY 2022 afforded by the Protecting Medicare and American Farmers From Sequester Cuts Act, which mitigated payment cuts in CY 2022. AOTA, along with a coalition of health care organizations, is currently working to engage Congress to take action.

Telehealth

CMS proposes to make several Medicare telehealth services that are temporarily available during the public health emergency (PHE) available through the end CY 2023. CMS plans to implement the telehealth provisions outlined in the Consolidated Appropriations Act, 2022, confirming the extension of telehealth services for a period of 151 days following the end of the PHE, allowing occupational therapy practitioners to continue to furnish telehealth services during this time. Following the expiration of the 151-day extension, OT practitioners would no longer be eligible to provide telehealth services, despite CMS making codes OT practitioners use during telehealth provision available through the end of CY 2023. AOTA is actively working with Congressional champions toward a permanent telehealth fix for the profession.

OTA Payment Differential

The proposed rule confirms continuation of the OTA and PTA payment differential implemented January 1, 2022, and outlines reimbursement at 88% of the Medicare fee schedule amount for services provided in whole or in part by a therapist assistant, which is 85% of the 80% of allowed charges. Advocacy on the SMART Act with Congressional champions is ongoing.

Evaluation and Management (E/M) Visit Coding

Similar to the approach CMS took in the CY 2021 PFS for office/outpatient E/M) visit coding and documentation, the agency is proposing to adopt additional changes in coding and documentation for other E/M visits. AOTA is analyzing how this may impact OT reimbursement.

Remote Therapeutic Monitoring (RTM) Services

In this proposed rule, CMS recommends creating four new HCPCS G codes to replace the current RTM codes 98980 (Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes) and 98981 (Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes).

The new HCPCS codes would specify whether RTM services were being delivered by a physician/non-physician practitioner (NPP) or by non-physician qualified health care professionals.

If these new HCPCS codes are adopted, the current codes 98980 and 98981 would become non-payable by Medicare.

Merit-based Incentive Payment System (MIPS)

In this proposed rule, CMS proposes to make several adjustments to the MIPS program, including eligibility for individuals, groups, and subgroups; performance measure adjustments and threshold levels; and changes to the MIPS Value Pathways (MVPs) to streamline and encourage participation.

MIPS Eligibility: Under this proposal, an individual clinician or group determined to be MIPS eligible based on the low-volume threshold determination during the initial 12-month segment of the MIPS determination period would continue to be eligible for an applicable performance period regardless of the results of the second segment of the low-volume threshold determination.

Performance Categories: CMS proposes updates to the MIPS quality measures and the improvement activities inventory including expansion of the definition of “high priority measure” to include health equity–related quality measures, reducing the inventory of quality measures from 200 to 194 through the removal of 15 and the addition of 9 MIPS quality measures, standardizing language related to equity, adding 4 new improvement activities related to CMS’s Six Health Equity Priorities for Reducing Disparities in Health, modifying 5 existing improvement activities, and removing 6 existing improvement activities.

CMS also proposes to increase the data completeness criteria threshold from 70% to at least 75% for CY 2024 and CY 2025 performance periods. The threshold is proposed to remain at 70% for the 2023 performance period as stipulated in the prior CY 2022 MPFS final rule.

CMS proposes to continue previous years’ reweighting of the Promoting Interoperability and Cost Measures Performance categories for OT services in CY 2023.

MIPS Performance Threshold: CMS proposes use of the CY 2019 MIPS payment year as the prior period used to determine the performance threshold for CY 2023 performance period/2025 MIPS payment year; the proposed performance threshold for the CY 2023 performance period year is 75 points.

MIPS Value Pathways (MVPs): The proposed rule adds the opportunity for public feedback on viable MVP candidates by posting draft versions of MVP candidates on the QPP website for a 30-day period before a candidate MVP is proposed in rulemaking, clarifies how MVPs can involve multiple clinician types that engage with the patient, adds 5 new MVPs, and revises the 7 previously established MVPS.

New HCPCs Codes Related to Chronic Pain

CMS proposes new HCPCS codes and valuation for chronic pain management and treatment services (CPM) for CY 2023, which includes ongoing communication and coordination between relevant practitioners furnishing care, such occupational therapy and physical therapy. This new code highlights the value of coordination with OT in chronic pain management.

Mental Health Care Services

As highlighted in the 2022 CMS Behavioral Health Strategy, CMS set a goal to improve access to, and quality of, mental health care services. In this proposed rule, CMS proposes regulatory revisions to reduce existing barriers to Medicare beneficiary access to behavioral health services. AOTA is evaluating potential opportunities available to OT practitioners as a result of the increased focus and development of additional payment policies related to behavioral health.