Additional Details
Payment Updates
- RBRVS Conversion Factor Reduction: For CY 2025, CMS is proposing a conversion factor of $32.36, a decrease of $0.93, or 2.80%, from the current CY 2024 conversion factor of $33.29.
- This update reflects the expiration of the 2.93% statutory payment increase for CY 2024, a 0.医疗保险准入和儿童健康保险计划再授权法案(MACRA)要求的0%法定更新因子, and a 0.5% RVU budget-neutrality adjustment.
- Compared to prior years, 2025年CY提议的规则不包括在各专业之间对RVU美元进行同样重要的再分配. In contrast, 法定支付增长到期预计将导致大多数专业的净减少.
- Time-Based Anesthesia Conversion Factor Reduction: CMS estimates the CY 2025 time-based anesthesia conversion factor to be $20.33, which represents a decrease of 2.1% from the 2024 rate of $20.77.
Coding Updates
- Office/Outpatient (O/O) and Evaluation and Management (E/M) Visits:For CY 2025, CMS建议,当基础代码由同一执业人员在每年访井的同一天报告时,允许支付O/O和E/M访井复杂性附加代码G2211, vaccine administration, 或任何医疗保险B部分在办公室或门诊提供的预防性云顶集团.
- 单独支付的G2211访问复杂度附加代码的付款在cy2024 PFS最终规则中最终确定. This add-on code is intended to reimburse for the time, intensity, 和PE资源,以建立与所有患者的纵向关系,并在较长时间内以一致性和连续性解决大多数医疗保健需求.
- Coding for Caregiver Training: CMS is proposing to establish new coding and payment for caregiver training, including but not limited to techniques to prevent decubitus ulcer formation, wound dressing changes, infection control, and medication administration. CMS is also proposing to allow the proposed CTS to be furnished via telehealth.
- Advanced Primary Care Management Services (APCM): For CY 2025, CMS建议通过三个新的HCPCS G代码,在PFS下为一套新的APCM云顶集团建立编码支付. 拟议的云顶集团包括高级初级保健的要素,如主要护理管理, transitional care management, and chronic care management.
- CMS is proposing that for CY 2025, 当云顶集团40011官网和非云顶集团40011官网从业人员是所需云顶集团的持续焦点并负责患者的初级保健时,他们可以为APCM云顶集团收费.
- Cardiovascular Risk Assessment and Management: For CY 2025, CMS建议对动脉粥样硬化性心血管疾病(ASCVD)风险评估云顶集团和风险管理云顶集团进行编码和付费.
- 当确定目前未诊断为心血管疾病的患者存在心血管疾病(CVD)风险时,建议的风险评估将与E/M访问一起完成.
- 拟议的风险管理云顶集团将包括与心血管疾病风险降低(阿司匹林)相关的云顶集团要素, blood pressure management, cholesterol management, smoking cessation) for beneficiaries at medium or high risk (>15% in the next 10 years) for CVD.
- Add-On for Infectious Diseases: For CY 2025, CMS正在提出一个新的HCPCS附加代码,以描述由接受过传染病专业培训的云顶集团40011官网执行的与确诊或疑似传染病相关的住院或观察护理的强度和复杂性.
Extension of Telehealth Provisions
- For CY 2025, CMS is proposing several modifications and expansions to the use of telehealth services, including the following:
- Proposal to add several services to the Medicare Telehealth Services List, 包括开始国内国际标准化比率(INR)监测前的示范和护理人员培训.
- 建议继续暂停对其后住院病人的次数限制, nursing facility visits, and critical care consultations.
- Proposal to approve use of two-way, real-time, 如果云顶集团40011官网或执业医师在技术上有能力使用交互式电信系统,而患者没有能力,则采用纯音频通信, or does not consent to, use of video.
- 建议永久采用直接监督的定义,允许云顶集团40011官网或监督执业医师通过实时视听互动电信提供监督, for a select subset of services. For all other services, CMS建议在12月31日前继续定义“即时可用性”,包括实时音频和视频交互电信技术, 2025.
Access to Behavioral Health
- For CY 2025, CMS提出了几项改革,以扩大行为健康云顶集团的使用和采用, including:
- 建议通过创建附加的G代码,为危机患者的安全规划干预措施建立编码和支付,该代码将与E/M访问或心理治疗云顶集团一起收费.
- 建议为紧急情况下从急诊室出院时提供的后续云顶集团建立每月计费代码. Specific protocols would be required post-discharge, including four calls a month.
- 建议通过创建三个新的HCPCS代码来建立数字精神健康治疗设备的医疗保险支付.
Finally, CMS正在征求意见,是否编码和支付密集门诊项目(IOP)云顶集团将适用于其他设置的护理, such as Certified Community Behavioral Health Clinics. CMS还在征求对提供危机稳定和非紧急紧急护理的设施的意见.
Other Updates
- Ambulatory Specialty Care Model Request for Information: CMS正在发布一份关于基于绩效激励支付系统(MIPS)价值路径(mvp)的潜在门诊专科护理模式设计的信息请求,旨在增加专家对基于价值的护理的参与并扩大激励.
- 对私人执业的物理治疗师及职业治疗师的监管: CMS提议允许私人执业的PTs和OTs对医师治疗助理(PTAs)和职业治疗助理(OTAs)进行一般监督. 这将与在机构环境中工作的PTs和ot的一般监督指南保持一致.
LEARN MORE ABOUT ECG'S RELATED SERVICES.
Edited by: Matt Maslin
Published July 16, 2024