Proposed Physician Fee Schedule Approves E/M Remake

The recently released 2023 Medicare physician fee schedule proposed rule featured physician payment decreases, but it also essentially gave the go-ahead for code updates.

By and large, in the 2023 physician fee schedule proposed rule, CMS is giving the go-ahead to align its billing requirements with recent evaluation and management (E/M) guideline changes put forth by the American Medical Association (AMA) that would integrate the full family of E/M services with the guidelines that currently govern office visit codes 99202-99215, according to Part B News.

That means "other" E/M services codes would adhere to the office visit guidelines that allow code level selection to be determined by medical decision-making or time, according to the agency, the history and exam elements would no longer be a factor.

The AMA guideline changes, effective January 1, 2023, will delete all observation care codes and merge them with the initial and subsequent hospital care codes, and make numerous other changes, most of which CMS is going forward with, according to the proposed rule.

One area where CMS diverges is in its approach to prolonged services. Instead of using CPT codes put forth by the AMA, CMS is launching a series of three prolonged service codes that providers can use depending on their setting, Part B News says.

Along with these, other proposals in the rule include but are not limited to:

• Delaying by one year the split-shared visits policy that was finalized in CY 2022 for the definition of substantive portion as more than half the total time.
• Extending the time that telehealth services are temporarily included on the telehealth services list during the PHE but are not included on a Category I, II, or III basis for 151 days following the end of the PHE
• Creating a new general behavioral health integration service that is personally performed by clinical psychologists or clinical social workers to account for monthly care integration where the mental health services furnished by these provider types are the focal point of care integration.
• Making an exception to direct supervision requirements under "incident to" regulations allowing behavioral health services provided under general supervision of a physician or non-physician practitioner (NPP) when the services or supplies are provided by auxiliary personnel incident to the services of a physician or NPP.