CMS Manual System

1 CMS Manual System Department of Health &. Human Services (DHHS). Pub 100-04 Medicare Claims Processing Centers for Medicare &. Medicaid Services (CMS). Transmittal 11146 Date: December 2, 2021. Change request 12519. Transmittal 11115, dated November 16, 2021, is being rescinded and replaced by Transmittal 11146, dated, December 2, 2021 to update the policy section in the business requirements. All other information remains the same. SUBJECT: Summary of Policies in the Calendar Year (CY) 2022 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services List I.

2 SUMMARY OF CHANGES: This Change request (CR) provides a summary of the policies in the CY. 2022 Medicare Physician Fee Schedule (MPFS) Final Rule and announces the Telehealth Originating Site Facility Fee payment amount. The attached recurring update notification applies to publication 100-04, chapter 12, section , chapter 13, section , and chapter 18, section 240. EFFECTIVE DATE: January 1, 2022. *Unless otherwise specified, the effective date is the date of service. IMPLEMENTATION DATE: January 3, 2022. Disclaimer for Manual changes only: The revision date and transmittal number apply only to red italicized material.

3 Any other material was previously published and remains unchanged. 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. III. FUNDING: For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract.

4 CMS does not construe this as a change to the MAC Statement of Work. 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.

5 IV. ATTACHMENTS: Recurring Update Notification Attachment - Recurring Update Notification Pub. 100-04 Transmittal: 11146 Date: December 2, 2021 Change request : 12519. Transmittal 11115, dated November 16, 2021, is being rescinded and replaced by Transmittal 11146, dated, December 2, 2021 to update the policy section in the business requirements. All other information remains the same. SUBJECT: Summary of Policies in the Calendar Year (CY) 2022 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services List EFFECTIVE DATE: January 1, 2022.

6 *Unless otherwise specified, the effective date is the date of service. IMPLEMENTATION DATE: January 3, 2022. I. GENERAL INFORMATION. A. Background: The purpose of this Change request (CR) is to provide a summary of the policies in the CY 2022 Medicare Physician Fee Schedule (MPFS). Section 1848(b)(1) of the Social Security Act (the Act) requires the Secretary to establish by regulation a fee schedule of payment amounts for physicians'. services for the subsequent year. The Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates payment policies and Medicare payment rates for services furnished by physicians and Nonphysician Practitioners (NPPs) that are paid under the MPFS in CY final rule also addresses public comments on Medicare payment policies proposed earlier this year.

7 B. Policy: CMS issued regulation number CMS-1751-F, Medicare Program: CY 2022 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Provider Enrollment Regulation Updates; Provider and Supplier Prepayment and Post-payment Medical Review Requirements. This CR provides a summary of the payment polices under the MPFS and makes other policy changes related to Medicare Part B payment. These changes are applicable to services furnished in CY 2022. Medicare Telehealth Services For CY 2022, CMS is not adding any new Category 1, Healthcare Common Procedure Coding System (HCPCS) codes to the list of Medicare telehealth services.

8 CMS is also not adding any new Category 2, Healthcare Common Procedure Coding System (HCPCS) codes to the list of telehealth services. Codes that were added to the telehealth services list on a Category 3 temporary basis, for the Public Health Emergency (PHE), will remain on the Medicare telehealth through the end CY 2023. This will allow time to gather more evidence and more comment on the Category 3 codes to support possible permanent addition to the list, or possible removal from the list. HCPCS codes G0422 and G0423, and CPT codes 93797 and 93798, are changing the status on the Medicare telehealth services list to Category 3, Available up Through the Year in Which the PHE Ends or December 31, 2023, whichever is later.

9 Additionally, from the provisions of the Consolidated Appropriations Act, 2021 (CAA), concerning services for the purpose of diagnosis, evaluation, or treatment of mental health disorders, effective immediately on and after the official end of the PHE for COVID-19, these services may continue to be offered as telehealth services. The previous telehealth restrictions limiting mental health services to be only available to beneficiaries residing in rural areas will no longer apply. The beneficiary's originating sites of a physician's office, a hospital, or other medical care settings, will also expand to include the beneficiary's home, which we clarify to include temporary lodging such as hotels and homeless shelters and nursing homes, located a short distance from the beneficiary's actual home and the originating site facility fee.

10 Does not apply. Medicare telehealth services require that the services be performed over real-time audio and visual interactive telecommunications. For purposes of diagnosis, evaluation, or treatment of mental health disorders, should the beneficiary not have the technical capacity or the availability of real-time audio and visual interactive telecommunications, or they do not consent to the use of real-time video technology, audio-only communication is permitted for telehealth mental health services to established patients located in their homes. The CAA of 2021, requires that an in-person, face to face, non-telehealth service takes place within six months of the first mental health telehealth services.