On Monday, August 3, 2020, the Centers for Medicare & Medicaid Services (CMS) issued the CY 2021 Physician Fee Schedule (PFS) proposed rule. We describe certain material provisions from the proposed rule below.

Telehealth

CMS proposes to add services to the Medicare telehealth list on a Category 1 basis.  The additional services include group psychotherapy, neurobehavioral status exams, care planning for patients with cognitive impairment, and home visits.  CMS also proposes creating a third temporary category of criteria for adding services to the Medicare telehealth list for services covered during the COVID-19 public health emergency (PHE).  These services include emergency department visits, psychological and neuropsychological testing, and home visits for established patients.  CMS proposes to retain these Category 3 services on the Medicare telehealth list through the calendar year in which the PHE ends.

Remote Physiologic Monitoring Services

CMS clarifies that it will require an established patient-physician relationship for remote physiologic monitoring (RPM) services after the COVID-19 PHE.  A provider is required to obtain a beneficiary’s consent for RPM services.  CMS proposes allowing consent to be obtained at the time RPM services are furnished to the beneficiary.

Direct Supervision

CMS is proposing to allow direct physician or practitioner supervision to be conducted using real-time, interactive audio and video technology through December 31, 2021.  This does not include audio-only telephone use.  CMS solicits comments as to whether any protective measures should be put in place, and whether the policy should be considered beyond the proposed timeframe.  CMS also seeks comments on potential patient safety issues, as well as concerns around fraud, waste and abuse related to this proposal.

Office/Outpatient Evaluation and Management

CMS proposes refining evaluation and management (E/M) coding and documentation policies to clarify when prolonged office/outpatient E/M visits may be reported and revise the times used for rate setting for this code set.  Commensurate with increases in values finalized in the CY 2020 PFS final rule, CMS is proposing to revalue the following code sets:

  • End-Stage Renal Disease (ESRD) Monthly Capitation Payment (MCP) Services
  • Transitional Care Management (TCM) Services
  • Maternity Services
  • Cognitive Impairment Assessment and Care Planning
  • Initial Preventive Physical Examination (IPPE) and Initial and Subsequent Annual Wellness (AWV) Visits
  • Emergency Department Visits
  • Therapy Evaluations
  • Psychiatric Diagnostic Evaluations and Psychotherapy Services

Scope of Practice and Related Issues

CMS proposes to permanently permit  nurse practitioners, clinical nurse specialists, physician assistants and certified nurse-midwives to supervise the performance of diagnostic tests.  In addition, CMS is proposing to permanently grant physical and occupational therapists the discretion to delegate the provision of maintenance therapy services to a therapy assistant.

CMS is also considering extending the PHE policies that allow teaching physicians to use audio/video real-time communications technology to interact with and supervise residents.  Currently, physicians involving residents in primary care centers may use audio/video communications technology to provide direction.  Additionally, resident services furnished outside the scope of the approved graduate medical education programs to inpatients of a hospital in which they have their training program are considered separately billable physicians’ services.  CMS solicits comments on whether these policies should be extended temporarily or be made permanent.

The proposed rule will be published in the Federal Register on August 17, 2020. Public comments on the proposed rule are due to CMS by October 5, 2020 by 5 PM EST.  The proposed rule may be downloaded from the Federal Register here.

The CMS CY 2021 PFS proposed rule fact sheet may be found here.