medicare
Nov 11, 2021

Physician Fee Schedule Final Rule Addresses Telehealth, Medicare Diabetes Prevention Program

On Nov. 2, 2021, the Centers for Medicare and Medicaid Services (CMS) released a final rule to update the Physician Fee Schedule (PFS) and address other Medicare Part B issues for Calendar Year (CY) 2022. The rule, which goes into effect Jan. 1, 2022, retains proposed changes concerning telehealth and important updates to the Medicare Diabetes Prevention Program (MDPP).

Telehealth Policies Update

Because of the COVID-19 Public Health Emergency (PHE), CMS temporarily expanded the number of Medicare telehealth services from 101 to 238. Temporary additions to the Medicare telehealth service list include cardiac rehabilitation, eye exams and speech therapy, among other things. The final rule retains this expanded list through Dec. 31, 2023. This will allow more time for CMS to evaluate whether the services should be permanently added.

The rule also updates restrictions relating to furnishing mental health telehealth service to reflect the amendments of Section 123 of the Consolidated Appropriations Act of 2021. A beneficiary’s home may now be an originating site for tele-mental health services. A patient receiving tele-mental health services must have an in-person visit with a practitioner within six months of the first telehealth appointment, with at least one in-person visit required every year. The rule allows exemptions to the in-person visit requirement based on beneficiaries’ situations.

In addition, the rule updates the definition of interactive telecommunications system to specify that telehealth services can include audio-only communications for mental health services under the following conditions: The patient is located in the patient’s home at the time of service, the provider has video telecommunications capability, and the patient is not capable of using video technology or does not consent to its use. The rule also includes a new modifier requirement for audio-only communications to verify that audio was used because of beneficiary choice or limitation and not due to a lack of provider capability.

CMS also finalized its proposal to revise the current regulatory language for Rural Health Clinic (RHC) or Federally Qualified Health Center (FQHC) mental health visits to include visits furnished using interactive, real-time telecommunications technology. This change will allow RHCs and FQHCs to report and receive payment for mental health visits furnished via real-time telecommunication technology in the same way they currently do for in-person visits, including audio-only visits when the beneficiary does not consent or cannot use video technology.

For additional details, view the CMS press release announcing the physician fee schedule or the final rule.

Medicare Diabetes Prevention Program Update

The final rule waives the provider enrollment Medicare application fee for suppliers that apply to MDPP after Jan. 1, 2022. CMS believes that waiving the application fee beyond the COVID-19 Public Health Emergency (PHE) will lead to higher MDPP supplier enrollment.

In addition, CMS is eliminating the Ongoing Maintenance Session phase which will change the MDPP service period to one year. This change will align the MDPP services time frame with the Centers for Disease Control and Prevention’s (CDC) National Diabetes Prevention Program. The Ongoing Maintenance sessions phase performance payments will then be redistributed to certain Core and Core Maintenance Session performance payments. Payment amounts for attendance-only achievement goals will also be increased beginning in 2022.

For more information, see the CMS press release on the final rule’s MDPP policies or the final rule.