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Complexity of care add-on cleared for same-day preventive services

11/18/2024

CMS finalized its proposal to relax restrictions on complexity of care add-on code G2211. The changes come in response to stakeholder concerns that the current CMS policy is disruptive to the way providers normally treat patients.

Batch of behavioral health services bolsters options, goes digital

11/18/2024

by: Roy Edroso

The changes proposed in the final rule for Medicare’s burgeoning behavioral health category have been finalized, expanding its purview beyond previous therapeutic models and even into digital care engaged by the patients themselves.

CMS slow-rolls QPP/MIPS progress, with eye toward electronic reporting

11/18/2024

by: Roy Edroso

The changes to the Quality Payment Program (QPP) and Merit-Based Incentive Payment System (MIPS) in the physician fee schedule final rule show CMS cautiously pushing forward into new forms of reporting and quantifying provider performance, with a focus on programs such as the Alternative Payment Model (APM) Performance Pathway (APP) Plus quality measure set and MIPS Value Pathways (MVP). The long-term hope is to achieve universal quality reporting for all patients regardless of payer.

After ‘banner year,’ Shared Savings pushes ahead with bold changes, good numbers

11/18/2024

by: Roy Edroso

The change of quality reporting method for accountable care organizations (ACO) in the Medicare Shared Savings Program (MSSP) from APP to APP Plus is significant, and will grow even more important with the proposed full switch-over to electronic clinical quality measures (eCQM) in five years. But other bold strokes, like the new prepaid model and the Health Equity Benchmark Adjustment (HEBA), are expected to have a more immediate effect.

New ‘enhanced care’ codes include tough reporting requirements

11/18/2024

by: Roy Edroso

The enhanced care management codes floated in the physician fee schedule proposed rule have been cleared, including “advanced primary care management services” (APCM) that promise to level up primary care treatment of patients with chronic conditions — if their providers can meet the terms.

Review the pay rates for 22 new HCPCS codes

11/18/2024

by: Julia Kyles, CPC

Take note of the final payments for new HCPCS codes that CMS will cover effective Jan. 1, 2025.

Fee schedule round-up: Dental services, MDPP, vaccine fee rates and more

11/18/2024

by: Richard Scott and Roy Edroso

Discover additional coverage and policy changes contained in the final fee schedule, from an expansion of dental services and vaccine payment rates to diabetes program changes and overpayment rules. The round-up below digs into the deeper, but no less important, portions of the final rule.

Conversion factor impact will vary for high utilization codes

11/18/2024

by: Julia Kyles, CPC and Laura Evans, CPC

You’ve read about the coming 2.8% pay cut that is on deck for 2025. However, a closer look at specific codes reveals that the impact of the cut will vary across services that are covered under the final 2025 Medicare physician fee schedule.

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