On August 7, 2023, the 2024 Medicare Physician Fee Schedule (MPFS) Proposed Rule was published to the Federal Register. Comments are due by 09/11/2023. This proposed rule puts forth proposed Medicare Part B reimbursement updates expected to be effective on 01/01/2024.

Tips for submitting comments:

  • Clearly identify the issues on which you are commenting.
  • There is no minimum or maximum length for effective comments.
  • Comments should be supported by factual information, sound reasoning, and/or include specific examples of how you or your patients in general would be impacted by the changes negatively or positively. For HIPAA purposes, please do not submit any Personally Identifiable Information (PII).
  • You may agree or disagree with a topic area. If you agree, you may thank CMS for the proposal. If you disagree, you may suggest an alternative.

After submission, your comment will be reviewed by the Health and Human Services (HHS) Department. Comments are then posted to Regulations.gov unless your comments are part of a mass submission campaign that are the same, are not related to proposed regulation, are not appropriate, are incomplete or you request your comment not be posted.

If you are interested in submitting a comment, click HERE. You need to refer to file code CMS–1784–P. Below are the topics and key points highlighted in previous Regulatory Compliance News posts.

Topic Area and Key Points in the Proposed Rule

MPFS Conversion Factor

The proposed 2024 PFS conversion factor is $32.7476. This proposed update is a decrease of $1.14, or approximately 3.34%, from the 2023 MPFS conversion factor of $33.8872. This would mean yet another decrease in Medicare B reimbursement to therapy in 2024.

Here is an example of reimbursement for CPT code 97530 Therapeutic Activities and the significant impact of year after year decrease to therapy reimbursement.* If this proposed decrease becomes final, CPT 97530 will be reimbursed at $36.03 in 2024.

2023 $37.62

2022 $38.07

2021 $39.43

2020 $40.42

*CPT codes vary by geographic locations. This example is the national payment amount before any reductions, such as Multiple Procedure Payment Reduction (MPPR) and/or the Assistant Modifier are deducted.

Definition of Direct Supervision for Private and Group Practice

During the COVID-19 Public Health Emergency (PHE), CMS changed the definition of “direct supervision” in Group and Private Practice settings to allow the supervising therapist to be immediately available through virtual presence using real-time audio/video technology, instead of requiring their physical presence. This temporary change is scheduled to end on 12/31/2023. CMS is proposing to continue with the changed definition through December 31, 2024.

CMS is asking for comments on this topic: Consider commenting on how this continued flexibility would benefit:

  • The ability to provide patients timely access to therapy
  • The ability to schedule patients at times that are convenient for them
  • Patient engagement and well-being
  • Patient outcomes and quality of care
  • Patient satisfaction
  • Workforce flexibility to provide patient care during a time of workforce shortage

New Caregiver Training Codes

This proposed rule is expected to be effective beginning January 1, 2024. Therapists can report caregiver training services (CTS) without the patient present when provided under a plan of care. The three new codes will be billed based on the individual patient whose caregiver(s) require training to assist with the treatment plan and facilitate functional performance in the home or community. CPT Code 9X015 is proposed for the initial 30 minutes of individual training with 9X016 as a 15-minute add-on code. 9X017 is proposed for group training to caregivers of patients.
How could this improve patient care?
How could this impact patient functional performance and outcomes?
How could this improve the patient’s quality of life and carryonver of skills in their environment?

Other Topics

  • Lymphedema Compression Treatment Items
  • Review of Misvalued Codes

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