CMS Manual System

1 CMS Manual System Department of Health & Human Services (DHHS) Pub 100-20 One-Time Notification Centers for Medicare & Medicaid Services (CMS) Transmittal 10160 Date: May 22, 2020 Change Request 11805 SUBJECT: Summary of Policies in the Calendar Year (CY) 2020 Medicare Physician Fee Schedule (MPFS) Public Health Emergency (PHE) Interim Final Rules I. SUMMARY OF CHANGES: This Change Request (CR) provides a summary of the policies in the CY 2020 Medicare Physician Fee Schedule (MPFS) Public Health Emergency (PHE) Interim Final Rules (IFC) entitled Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (CMS-1744-IFC) and Medicare and Medicaid Programs, Basic Health Program, and Exchanges.

2 Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program (CMS-5531-IFC). EFFECTIVE DATE: June 12, 2020 *Unless otherwise specified, the effective date is the date of service. IMPLEMENTATION DATE: June 12, 2020 Disclaimer for Manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged.

3 However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. II. CHANGES IN Manual INSTRUCTIONS: (N/A if Manual is not updated) R=REVISED, N=NEW, D=DELETED-Only One Per Row. R/N/D CHAPTER / SECTION / SUBSECTION / TITLE N/A N/A III. FUNDING: For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work.

4 The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements. IV. ATTACHMENTS: One Time Notification Attachment - One-Time Notification Pub.

5 100-20 Transmittal: 10160 Date: May 22, 2020 Change Request: 11805 SUBJECT: Summary of Policies in the Calendar Year (CY) 2020 Medicare Physician Fee Schedule (MPFS) Public Health Emergency (PHE) Interim Final Rules EFFECTIVE DATE: June 12, 2020 *Unless otherwise specified, the effective date is the date of service. IMPLEMENTATION DATE: June 12, 2020 I. GENERAL INFORMATION A. Background: This Change Request (CR) provides a summary of the policies in the interim final rule with comment period (IFC) entitled Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (CMS-1744-IFC); and in the IFC entitled Medicare and Medicaid Programs, Basic Health Program, and Exchanges.

6 Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program (CMS-5531-IFC). In the event of a declared public health emergency (PHE), the United States Secretary of Health has the authority to temporarily waive or modify application of certain Medicare requirements during the emergency period. A PHE was declared by the Secretary on January 31, 2020, for the 2019 Novel Coronavirus (COVID-19).

7 In addition, the President declared a national emergency concerning COVID-19 on March 13, 2020. The purpose of this Change Request (CR) is to provide a summary of the recent policy changes to the Medicare Physician Fee Schedule (MPFS) during the PHE. The Centers for Medicare & Medicaid Services (CMS) has recently issued two (IFCs) that revised payment policies and Medicare payment rates for services furnished by physicians and nonphysician practitioners (NPPs) that are paid under the MPFS during the PHE. B. Policy: This Change Request provides a summary of the payment polices, revisions to the MPFS, and other policy changes related to Medicare Part B payment, as part of the PHE for the COVID-19 pandemic under the following IFCs: Regulation number CMS-1744-IFC: Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency, went on display on the CMS website on March 31, 2020.

8 Regulation number CMS-5531-IFC: Medicare and Medicaid Programs, Basic Health Program, and Exchanges; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program, went on display on the CMS website on April 30, 2020. These changes are applicable to services furnished during the PHE. Medicare Telehealth Services Payment for Medicare Telehealth Services Under Section 1834(m) of the Social Security Act (the Act) Pursuant to the waiver authority added under section 1135(b)(8) of the Act by the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, to facilitate the use of telecommunications technology as a safe substitute for in-person services, CMS has added, on an interim basis, many services to the list of eligible Medicare telehealth services.

9 This list of added services included initial inpatient and nursing facility visits, emergency department visits, initial and subsequent observation services, inpatient nursing facility and observation discharge day management home visits, and a number of physical therapy, occupational therapy, and speech language pathology services. On an interim basis, CMS eliminated several requirements associated with particular services furnished via telehealth, and clarified several payment rules that apply to other services that are furnished using telecommunications technologies that can reduce exposure risks.

10 Specifically, we eliminated frequency limitations for subsequent inpatient and nursing facility visits and critical care consults, and instructed practitioners to identify whatever place of service they would have had the service occurred in person, and to append the 95 modifier to the claim to identify it as Medicare telehealth. This is to assure that the payment rate would be equal to that which ordinarily would have been paid under the PFS were the services furnished in-person. NOTE: Critical Access Hospitals (CAH) method II should continue to report Distant Site services with modifier GT.