Physician Fee Schedule – Final CY 2022

The Centers for Medicare and Medicaid Services (CMS) released its final CY 2022 Physician Fee Schedule (PFS) policies for Medicare last week. Unless otherwise noted, the policies will take effect on January 1, 2022. Much of the proposals published in July 2021 for public commentary remain intact, but CMS did make several modifications and clarifications.
Adding Services to the Permanent Telehealth List
In the previous year’s PFS, CMS created a “Category 3” list of services for telehealth that contained some of the temporary codes that had been approved for reimbursement during COVID-19, if the service was delivered via telehealth. These Category 3 codes will now remain through the end of 2023 which CMS noted should provide sufficient time to determine if they should be moved to the permanent telehealth codes for reimbursement based on a Category 1 test (similar to codes currently existing on the permanent list) or Category 2 (sufficient evidence to show clinical benefit to patient if provided via telehealth).  Additionally, CMS added four additional codes for cardiac rehabilitation to Category 3 (see factsheet for codes).
Mental Health Services
Per the Consolidated Appropriations Act (CAA) passed in December 2020, CMS will be implementing the policy of allowing mental health services to be delivered via telehealth in the home without the rural restriction applying if there is an in-person visit where an item or service was delivered to the patient and was covered by Medicare, six-months prior to telehealth being used.  Thereafter, there must be an in-person visit with the provider at least 12 months before the service is delivered via telehealth, with some limited exceptions.  Other clarifications were also made around this policy.  The in-person visit requirement does not apply if: The patient meets the rural and site location limitations OR If the patient is receiving treatment for a substance use disorder and being treated for a co-occurring mental health condition or is being treated for end stage renal disease. Audio-Only
Audio-only may be used to deliver treatment, evaluation and diagnosis of mental health if certain conditions are met: It is for an established patient The home is the eligible originating site There must have been a six-month in-person item or service provided prior to telehealth being used, a 12-month subsequent in-person visit Provider has capability to provide live video but is utilizing audio-only because patient chose or cannot use live video Note that audio-only mental health services will also require the six-month/12-month subsequent in-person visit as well.
The definition of a mental health visit for federally qualified health centers (FQHCs) and rural health clinics (RHCs) has been redefined to allow for the provision of those services via live video and audio-only.  Audio-only can only be used if the patient is not capable of using live video or consents to the use of audio-only.  FQHCs and RHCs will also need to meet the in-person visit six-months prior to telehealth being used and 12-month subsequent visit requirement if the patient is receiving services in the home.  These services are not regarded as “telehealth” by CMS as only a legislative change can make FQHCs/RHCs distant site providers.  This is a redefining of what a “mental health visit” means for these entities. Therefore, the usual limitations on telehealth such as needing to be in a rural area, would not apply.  FQHCs and RHCs will receive their usual rates for these visits.
Communications Technology Based Services (CTBS)
Communications Technology Based Services (CTBS) are services that utilize telehealth technology to deliver the service, however, unlike telehealth, there is no comparable in-person service for them.  CMS regards telehealth delivered service as a direct replacement for a type of service that would typically take place in-person. With CTBS, technology has enabled the provision of services that normally would not take place in-person. Therefore, CTBS is not regarded as “telehealth” by CMS in Medicare and are not subject to those policies, though CMS has created their own policies that apply to CTBS services.  CMS finalized the addition of CTBS code G2252 which will allow for a longer virtual check-in than in previous years, as well as five remote therapeutic monitoring (RTM) codes and five codes for Principal Care Management (PCM) and Chronic Care Management (CCM).  More detail is provided in CCHP’s new PFS factsheet.