On Thursday, July 13, the Centers for Medicare & Medicaid Services (CMS) filed the 2024 Medicare physician fee schedule and Quality Payment Program proposed rule, which includes potential revisions to payment policies under the physician fee schedule, Quality Payment Program and other Part B payment policies. The AASM health policy team performed an analysis of the proposed rule and responded to several proposals that would potentially impact sleep medicine care and reimbursement, if finalized. The AASM submitted a comment letter in response to the rule, advocating on behalf of all members. Key highlights are provided below.
2024 Rate-Setting and Medicare Physician Payment
CMS proposed a 3.36% decrease in the Medicare Conversion Factor.
The AASM strongly opposed the proposed decrease, citing the potential negative impact on sleep medicine professionals and their ability to continue providing high-quality care to patients with sleep disorders. The AASM realizes that this conversion factor accounts for many considerations, including the statutorily required budget neutrality adjustment of -1.25% due to the potential adoption of a new office visit add-on code. However, the proposed additional payment reductions will make it increasingly difficult for sleep facilities to be sustainable. Sleep medicine professionals continue to navigate the already significant reductions in payment, implemented over the last three years, while simultaneously navigating soaring prices due to record inflation, ongoing staffing shortages, the continued impact of a significant device recall used to treat patients with sleep apnea, and physician burnout. The AASM also shared support for HR 2474, the Strengthening Medicare for Patients and Providers Act, and urged CMS to significantly reduce the budget neutrality adjustment while working with Congressional leaders to address physician payment.
Medicare Economic Index
CMS is delaying implementation of a revision to the Medicare Economic Index (MEI) and solicited comments regarding other potential implementation strategies.
The AASM, along with more than 170 other health care organizations, encouraged CMS to delay implementation until the American Medical Association (AMA) completes the Physician Practice Information (PPI) survey, which will collect data from financial experts at physician practices about cost data at the specialty level, ensuring that the updated MEI weights are based on reliable and accurate data for rate setting. The AASM will continue to urge members to ensure that financial experts at their practices participate in this survey.
Potentially Misvalued Services Under the PFS
CPT codes 94762 and 95800 were nominated as potentially misvalued codes due to practice expense.
Codes 94762 (Noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight monitoring (separate procedure)) and 95800 (Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time) were nominated as potentially misvalued codes by an interested party, and CMS requested comment as to whether the codes may be misvalued due to the practice expense. After the AASM CPT and RUC advisors’ review of the practice expense inputs in question, the AASM does not believe that 94762 is misvalued and recommends that CMS reject the recommendation. However, the AASM agrees that 95800 may be misvalued and recommends a review of invoices to determine a more accurate value for the WatchPAT One device.
Payment for Medicare Telehealth Services
- The AASM strongly urged CMS to allow for the provision of telehealth visits without having to publicly display the physician’s home address on Medicare websites that include a physician lookup feature, due to privacy and safety concerns.
- The AASM supported the CMS proposal to reimburse claims billed with POS code 10 (telehealth provided in patient’s home) at the non-facility rate, while claims billed with POS code 02 continue to be reimbursed at the facility rate.
- The AASM strongly supported continued payment for 98966 – 98968 through the end of 2024, in alignment with provisions in the Consolidated Appropriations Act of 2023, to allow non-physicians to continue billing for these services.
- The AASM continued to urge CMS to consider making the telehealth flexibilities permanent with regard to in-person requirements for the following services:
- Mental Health Telehealth Services
- Direct Supervision via Use of Two-way Audio/Video Communications Technology
- Supervision of Residents in Teaching Settings
Valuation of Specific Codes
The AASM strongly supported the CMS proposal to accept the RUC recommendations for all 12 of the recently established and surveyed phrenic nerve stimulation codes, as well as the proposed practice expense refinements for code 3X014, including the post-operative visits (total time) and the equipment time for the exam table equipment. The AASM collaborated with the American College of Cardiology and the Heart Rhythm Society on this effort, and we thank all members who participated in the survey!
Evaluation and Management (E/M) Visits
The AASM recommended that implementation of the new E/M add-on code, G2211 Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition, be delayed further until CMS can provide clear, concise instructions on when it is appropriate to use this code. Additionally, given the confusing nature of the code and associated guidance, the AASM suggested the estimated utilization be revisited upon initial implementation.
The AASM strongly urged CMS to move forward by adopting the CPT guidelines for determining when a physician may report E/M services furnished in a facility setting and where a physician and nonphysician practitioner provide the service together, as adoption of this guidance would allow physicians or qualified health professionals (QHPs) to report split or shared visits based on time or medical decision making.
Advancing Access to Behavioral Health
The AASM collaborated with the American Psychological Association to draft and harmonize comments on adjustments to payment for timed behavioral health services and responded to a request for information on digital therapies, including digital cognitive behavioral therapy (CBT). The AASM also provided comments on the applicability of existing remote therapeutic monitoring codes to digital CBT, as the CPT advisors supported a code change proposal in this regard.
Updates to the Quality Payment Program
MIPS Payment Adjustments
The AASM suggested holding the performance threshold at 75 points until CMS and Congress can work together to address physician payment reform, as noted in HR 2474.
Previously Finalized Quality Measures with Substantive Changes Proposed for the CY 2024 Performance Period/2026 MIPS Payment Year and Future Years
The AASM shared information about the AASM quality measure methodology and explained the necessity of updating the Sleep Apnea: Assessment of Adherence to Positive Airway Pressure Therapy quality measure, to support finalizing the updated version in the Quality Payment Program.
Quality Care for the Treatment of Ear, Nose, and Throat Disorders MVP
The AASM strongly supported the inclusion of the proposed Sleep Apnea: Severity Assessment at Initial Diagnosis measure in the Treatment of Ear, Nose, and Throat Disorders MVP, along with the inclusion of all other proposed quality measures and improvement activities in this MVP.
As CMS reviews all comments and prepares for publication of the 2024 final rule, AASM will continue to advocate for members to receive appropriate reimbursement for the delivery of high-quality care to patients with sleep disorders. Members may send questions about the proposed rule or AASM payer advocacy efforts to firstname.lastname@example.org.