CMS Coverage Changes Starting in 2023

2023 is fast approaching, and so are new changes from the Centers for Medicaid & Medicare (CMS)! These changes are part of an overall effort to expand access to high-quality care and emphasize the importance of coordinated, integrated whole-person care. CMS is also focused on modernizing coverage for behavioral health and reducing the administrative burden on healthcare professionals.

New Changes to Behavioral Health Coverage

CMS is implementing a variety of changes designed to strengthen the equity and quality of behavioral health care, including:

    • Improving access to substance abuse disorders prevention, treatment, and recovery
    • Ensuring effective pain management treatment
    • Improving access to quality mental health services
    • Leveraging data for effective actions to impact behavioral health

To address a shortage of behavioral professionals, CMS is adjusting its policies to:

    • Expand primary care teams to include clinical psychologists and licensed social workers
    • Expand supervision to general, not direct, for Licensed Professional Counselors, Licensed Marriage and Family Therapists, and other appropriate therapists

Updates to Chronic Pain Management

Chronic pain is defined as “persistent or recurrent pain lasting more than three months.” For bundled monthly payments, providers should use HCPCS codes GYYY1 and GYYY2. In addition, two practitioners can bill HCPCS code GYYY1 in the same month.

Use of HCPCS GYYY1 or GYYY2 requires:

    • Person-centered care plan
    • Health literacy counseling
    • Pain rating
    • First visit takes place in-person (subsequent visits can be conducted via telehealth)

New Opioid Use Disorder & Opioid Treatment Program Guidelines

As part of its ongoing efforts to evolve treatment for opioid use disorders, CMS is adjusting its coverage related to treatment program guidelines.

    • CMS is increasing the base therapy time from 30 minutes to 45 minutes per week, with the add-on code of 30 minutes still available.
    • Mobile treatment units are allowed
    • Providers must bill once per week regardless of location
    • Video-audio treatment is permitted

Reducing Administrative Burden

To streamline process and reduce the amount of administrative work for healthcare professionals, the following items are no longer required:

    • Certificates of Medical Necessity (CMN)
    • DME Information Forms (DIF)
    • Eliminating redundant information now found on claim or medical record

After January 1, 2023, claims with these forms will be rejected:

    • Oxygen
    • Pneumatic Compression Devices
    • Osteogenesis Stimulators
    • Transcutaneous Electrical Nerve Stimulators
    • Seat Lift Mechanisms
    • External Infusion Pumps
    • Enteral and Parenteral Nutrition

Dental Care Coverage When Integral to Medical Services

Dental exams will be covered before procedures and prior to an organ transplant. CMS is considering adding coverage before joint replacement and cancer treatment.

Potential Upcoming Changes

CMS has delayed its decision on share/split services using time, as well as Appropriate Use Criteria for advanced diagnostic imaging. CMS is seeking comment on global surgical package valuation and extending and evaluating audio-only telehealth services.

For a deeper dive into 2023 Coding Changes, you can watch our recent webinar to get a jump on new updates for the coming year.

Questions or Comments?