CMS Proposed Updates to Medicare Physician Fee Schedule Payments for Calendar Year 2025

– Comment by September 9. This proposed rule from the Centers for Medicare & Medicaid Services (CMS), issued on July 10, 2024, seeks public comment on payment updates and policy changes to Medicare’s physician fee schedule payments and includes other proposals affecting Medicare and Medicaid beneficiaries. Proposals include payment for both in-person and virtual caregiver training services, permitting certain health care providers to provide virtual direct supervision to auxiliary personnel when required, temporary extension of virtual supervision of residents by teaching physicians in certain cases, permitting Opioid Treatment Programs (OTPs) to furnish periodic assessments using audio-only communications technology when video is not available on a permanent basis, and the return of statutory restrictions on geography, site of service, and practitioner type for non-behavioral health telehealth services. The proposed rule also includes proposed updates applicable to Rural Health Clinics (RHCs), including to allow RHCs to bill for administration of part B preventive vaccines at time of service, continue to require provision of primary care services but no longer enforce “primarily engaged in furnishing primary care services,” seeks comment on how to define “mental diseases” as related to the requirement that RHCs cannot be “primarily engaged in the treatment of mental diseases,” and to eliminate productivity standards. The rule also includes updates to the Quality Payment Program, Medicare Shared Savings Program, and several other proposals affecting RHCs including removal of hemoglobin/hematocrit from the six required lab services and permitting RHCS to bill individual HCPCS care management codes instead of G0511. In addition, coverage for necessary dental exams and procedures are being considered for certain treatment services and expansion of colorectal cancer screenings to promote better access for all beneficiaries is being proposed.

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