Codes to Know for Transformation – Physician Fee Schedule

In our second post on the Physician Fee Schedule (PFS) final rule (more information HERE) we explore some of the new and modified codes available to help your practice in its transformational work.

The Centers for Medicare & Medicaid Services (CMS) made some important changes to its chronic care management (CCM) codes; making it easier for general use as well as expanding the ability of Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) to offer the service. CMS has allowed practices to bill for chronic care management for the past couple of years. In the final rule, the agency reduced prerequisite conditions and access requirements for practices that offer the service. The final rule also simplifies standards for obtaining beneficiary consent and documentation.

In a major change for RHC and FQHC providers, those facilities may now provide CCM with the assistance of individuals under general supervision. This change will increase the ability of small and rural practitioners to provide ongoing support for their most complex patients.

CMS also added a number of new codes to emphasis its focus on behavioral health integration. Four new codes proposed in August were finalized that may be utilized when a beneficiary has one or more behavioral health conditions that require varying levels of assessment, care planning, and intervention.

Finally, CMS also added new codes for CY2017 that support dementia assessment and advance care planning via telehealth. Practices should explore how these codes can be used to increase patient engagement and help manage important patient conditions.

Caravan Health’s issue brief on billing codes to help with transformational efforts can be found here. Look for one additional blog post on the PFS final rule that explores the expansion of Medicare’s Diabetes Prevention Program.

2017-09-13T20:09:57+00:00 November 30th, 2016|CMS, Legislation & Policy|