Policy, Physicians

CMS extends telehealth coverage for behavioral health in 2022 physician fee schedule

The Centers for Medicare and Medicaid Services dropped its physician fee schedule for next year. It would bolster coverage of telehealth visits for behavioral health and vaccine payments, but would also reduce the conversion factor used to calculate fee-for-service payments. 

The Centers for Medicare and Medicaid Services is once again looking at ways to extend coverage of telehealth services beyond the Covid-19 pandemic. In particular, the agency is looking to extend Medicare’s coverage of telehealth for behavioral health visits, as detailed in its final physician fee schedule for 2022. 

CMS dropped the 2,400-page final rule on Tuesday afternoon. Here are a few highlights: 

Broader coverage of  telehealth visits for behavioral health
CMS would remove geographic restrictions around telehealth visits for mental health services. Medicare would cover visits in patients’ homes, including for diagnosis, evaluation or treatment of mental health conditions.

Medicare would also cover audio-only visits for some services, including counseling, therapy, and treatment for substance use disorders provided through Opioid Treatment Programs. It would also cover mental health visits offered by rural health clinics and federally qualified health centers.

In a news release, CMS stated that changes were intended to make mental healthcare available to people in areas with poor broadband infrastructure and in rural communities. 

Changes to clinical labor rates
CMS would reduce the conversion factor used to calculate fee-for-service payments to $33.59, down from $34.89 last year. A 3.75% increase that Congress had temporarily instated in late 2020 is set to expire at the end of the year.

CMS is also making some changes to clinical-labor pricing that would go into effect over the next four years. Primary care specialties, such as family practice, geriatrics and internal medicine, are expected to see their pay increase. On the other hand, specialists in radiation oncology and interventional radiology would see their pay decrease. This would be the first time CMS had updated its wage data in 20 years.

More payments for vaccines
Specifically, CMS will pay more for vaccines for influenza, pneumonia, hepatitis B and other common diseases. It will nearly double Medicare Part B payments for administering these vaccines from $17 to $30. For Covid-19 vaccines, however, payments will remain the same, at $40 per dose. 

Paying PAs directly
Medicare would be able to make payments directly to physician assistants under Part B. Currently, PAs can only bill through an employer or independent contractor, but starting in January, they will be able to bill Medicare directly.

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