CMS 2024 Proposed Rule Policy Updates 

On July 13, 2023, the Center for Medicare and Medicaid Services (CMS) released the CMS 2024 Proposed Rule and Medicare Physician Fee Schedule, including possible Medicare payments under the Physician Fee Schedule and other Medicare Part B issues policy updates.

While the CMS 2024 proposed rule contained no new CPT codes, it addressed ambiguities in telehealth, remote therapeutic monitoring (RTM), and remote patient monitoring (RPM) regulations. This article explores key takeaways from Medicare’s proposed changes affecting telehealth, remote patient monitoring, and remote therapeutic monitoring.

Telehealth CMS 2024 Proposed Rule Takeaways

The CMS 2024 proposed rule has proposed extending several telehealth provisions through the end of 2024. This includes reimbursement at non-facility rates for specific telehealth services provided in a patient’s home. It also adds physical therapists, occupational therapists, speech-language pathologists, and audiologists to the list of distant site practitioners. The proposed rule also proposes a new process for adding, removing, or otherwise changing Medicare Telehealth Service list codes. This would create differential payment based on the place of service.

Remote Patient Monitoring CMS 2024 Proposed Rule Takeaways

RPM and RTM are available only to established patients, but those who received remote monitoring during the PHE are now considered established. Practitioners can choose remote patient monitoring or therapeutic monitoring alongside certain care management services without double-counting time.

Same Patient Billing for RPM and RTM 

CMS 2024 proposed rule aims to clarify RPM and RTM billing for patients with multiple devices. CMS states that both services cannot be billed together, and time cannot be double-counted by billing concurrently. Only one practitioner can bill reasonable and necessary services associated with all devices, once per patient every 30 days and only after at least 16 days of monitoring data. 

16-Day Requirement

CMS still requires monitoring over 16 days within 30 days, causing concerns for patients who may benefit from fewer days of monitoring.

Payment During Global Surgery Periods

CMS proposes to clarify rules for using remote monitoring during global periods for surgery. Patients can receive either RPM or RTM services, but not both simultaneously. The practitioner will receive separate payments for one service only and the global service payment. They must meet all requirements for the global service and any other service during the global period.

Payment for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)

CMS is considering allowing FQHCs and RHCs to bill separately for RPM and RTM services.

RPM and Primary Care Services under Medicare Shared Savings Program (MSSP)

CPT codes 99457 and 99548 may be classified as primary care services for MSSP beneficiary assignments.

Additional CMS 2024 Proposed Rule Takeaways

The following section covers key takeaways for additional virtual care management services. 

For the calendar year 2024, physician fees will reduce by 1.25%. Accordingly, the conversion factor will decrease by $1.14 (or 3.34%), dropping from $33.89 in 2023 to $32.75 in 2024.

Health Equity-Focused Coding and Payment Proposals

The CMS 2024 proposed rule outlines several essential services to assist underserved communities. These proposals include caregiver training programs, separate coding and payment for community health integration services, payment for principal illness navigation services, and coding and payment for social determinants of health risk assessments.

Promoting Whole-Person Care

To further improve care quality, CMS has implemented changes to the Medicare Shared Savings Program (MSSP) that encourage whole-person care. The proposed changes include revisions to Accountable Care Organization (ACO) assignment and financial benchmarking methodology.

Providing Feedback on the 2024 Proposed Rule

Stakeholder comments are welcomed on the CMS 2024 proposed rule during the 60-day comment period, which will close on Sept. 11, 2023. In early November 2023, CMS will publish the 2024 Final Rule to solidify the path forward for Medicare beneficiaries and healthcare providers.