Article Detail - JE Part A
Federally Qualified Health Center (FQHC) Prospective Payment System (PPS): Final Rule Updates
2024 Payment Rate Update
Effective January 1, 2024, FQHC PPS base payment rates
- FQHC PPS rate is $195.99
- Grandfathered Tribal (GFT) FQHC PPS rate is $667
View the complete CMS Change Request (CR) 13398 and CMS Change Request (CR) 13511
Telehealth Services
- The continued payment for telehealth services through December 31, 2024
- Delayed in-person requirements within six months prior to initiating mental health services
- Temporary expansion of originating sites for furnishing telehealth for billing code Q3014, servicing location is the FQHC clinic
- Expansion of distant-site telehealth practitioners to include qualified occupational therapists (Ots), physical therapist (PTs), speech-language pathologists (SLPs), registered dieticians (RDs), nutrition professionals, audiologists, licensed marriage and family therapists (MFTs), and licensed mental health counselors (MHCs)
View the complete CMS Medicare Learning Network (MLN) Matters (MM) 13452 - Medicare Physician Fee Schedule Final Rule Summary: CY 2024 and MLN901705 Telehealth Services Fact Sheet
Expansion of HCPCS code G0511
General Care Management services to include Community Health Integration (CHI), Principal Illness Navigation (PIN), PIN-Peer Support (PIN-PS) services, Remote Physiologic Monitoring (RPM), and Remote Therapeutic Monitoring (RTM) services
- CHI services: G0019 (60 minutes per calendar month) and +G0022 (each additional 30 minutes per calendar month)
- PIN services: G0023 (60 minutes per calendar month), +G0024 (each additional 30 minutes),
- PIN-Peer Support (PIN- PS) services: G0140 (60 minutes), +G0146 (each additional 30 minutes)
- RPM services limited to established patients: 99453, 99454, 99457 (20 minutes), 99091
- RTM services: 98975, 98976, 98977, 98980 (20 minutes)
- FQHCs may bill G0511 multiple times in a calendar month as long as medically reasonable and necessary, meet all the coding requirements for each service codes, and time cannot be accounted twice
View the complete CMS Medicare Learning Network (MLN) Matters (MM) 13452 - Medicare Physician Fee Schedule Final Rule Summary: CY 2024 and MLN9201074 - Health Equity Services in the 2024 Physician Fee Schedule Final Rule
New Services
- Social determinants of health (SDoH) risk assessments: G0136 (5-15 minutes) added to the Annual wellness visit (AWV) as an optional visit with no cost sharing, or in conjunction with a qualifying evaluation and management (E/M) visit with applicable cost sharing
- Caregiver training services: 97550 (initial 30 minutes), +97551 (each additional 15 minutes) as part of individualized treatment plan or therapy plan of care for patients with a mental or physical health diagnosis
Supervision and Consent
- Definition of direct supervision has been expanded to allow for virtual presence
- Supervision for behavioral health services furnished "incident to" physician services changed from direct to general
- Beneficiary consent for care management services and virtual communication may be obtained through general supervision (e.g., auxiliary personnel or under contract)
View the complete CMS Medicare Learning Network (MLN) Matters (MM) 13452 - Medicare Physician Fee Schedule Final Rule Summary: CY 2024
Mental Health Services
- Finalized technical changes to Intensive Outpatient Program (IOP) benefits, services, certification, plan of care requirements, and payment rules, including for three services per day based on hospital rate
- Must report condition code 92 to indicate IOP claims and revenue code 0905 when billing for IOP services (revenue code 0519 for FQHC Supplemental MA Payments)
- Append modifier 95 on telehealth claim services furnished by clinician in the hospital and outpatient therapy providers
Make sure your billing staff knows about these changes.
Date Reported: 03/12/24
