CMS proposes new payments for digital health in 2025 PFS draft rule

On Wednesday, the Facilities for Medicare & Medicaid Companies (CMS) launched its proposed calendar yr 2025 doctor payment schedule, which incorporates suggestions on protection of digital well being instruments, together with digital therapeutics and telehealth providers. 

To assist entry to behavioral well being providers, CMS proposed that Medicare pay for digital psychological well being remedy gadgets used at the side of a behavioral well being remedy plan. 

“We’re proposing to create three new HCPCS codes and we’d monitor how digital psychological well being remedy gadgets are used as a part of general behavioral well being care,” in keeping with the company’s assertion.  

“We’re additionally proposing to create six G codes to be billed by practitioners in specialties whose lined providers are restricted by statute to providers for the prognosis and remedy of psychological sickness (together with scientific psychologists, scientific social staff, marriage and household therapists, and psychological well being counselors) to reflect present interprofessional session CPT codes utilized by practitioners who’re eligible to invoice E/M visits.”

CMS additionally proposed including new providers to the telehealth providers record, together with telehealth for caregiver coaching, opioid use dysfunction remedy, and audio-only telehealth providers if a affected person is incapable of utilizing video providers or doesn’t consent to video. 

The company additionally proposed continued protection of telehealth providers launched in the course of the COVID-19 pandemic; nevertheless, these providers are set to run out on the finish of this yr. Congress might want to lengthen protection for them to stay in impact. 

The draft PFS is underneath a 60-day remark interval, expiring on September 9.

THE LARGER TREND

One other facet of the PFS is a proposal for lowering doctor funds by 2.93% in 2025, as reported by MobiHealthNews sister publication Healthcare Finance Information. 

In response to the proposal, the president of the American Medical Affiliation mentioned, “The loss of life by a thousand cuts continues.”

The lower contrasts with the two.6% enhance in Medicare reimbursement for hospital outpatient departments subsequent yr.