E/M Services
After revising the office and outpatient evaluation and management (E/M) code sets in CY 2021, CMS finalized refinements to coding and documentation requirements for hospital inpatient, observation, and some other E/M visits for 2023 to align with the 2021 changes. A discussion of these coding changes can be found in an October 2022 Bulletin article entitled “What Surgeons Should Know: 2023 Changes to Reporting Inpatient and Observation Evaluation and Management Services.”†
Split (or Shared) Services
CMS previously finalized changes to its policies for split (or shared) E/M visits. Such changes, applicable to a facility-based visit by a physician furnished in conjunction with a nonphysician practitioner (NPP) and originally set to begin January 1, 2023, allowed the practitioner—either the physician or NPP—who provided the “substantive portion” of the visit to bill for the services furnished. As part of this policy, a substantive portion was to be defined by comparing the time spent by each clinician and determining who spent more time with the patient. CMS will delay implementation of this policy until 2024, and in 2023, providers who furnish split/shared visits will continue to select the billing practitioner either by (a) who provided the history, physical exam, or medical decision-making (MDM); or (b) who spent more than half of the total time on the service.
In 2024, unless CMS revisits the policy, the substantive portion will be defined as more than half of the total time that the physician and NPP spent performing the split (or shared) visit (see Table 1).‡ The substantive portion may include time spent with or without direct patient contact.
Telehealth Services
In accordance with the Consolidated Appropriations Act, 2022 (CAA), CMS will allow certain services added during COVID-19 to the Medicare telehealth covered services list to remain on the list for 151 days after the expiration of the public health emergency (PHE). The CAA also enacted additional flexibilities for the 151-day post-PHE period and expanded the scope of telehealth originating sites to include any site in the US where the beneficiary is located at the time of the telehealth service, including an individual’s home.
Colorectal Cancer Screening Services
To broaden access to colorectal cancer (CRC) screening, CMS modified coverage and payment limitations of certain CRC screening tests to begin at age 45 instead of 50. The regulatory definition of CRC tests also was expanded to include follow-up screening colonoscopies after a Medicare-covered non-invasive, stool-based CRC screening test returns a positive result. Such tests include guaiac fecal occult blood tests, immunoassay fecal occult blood tests, and Cologuard™ Multitarget Stool DNA tests. CMS will pay for follow-up colonoscopies as screening tests—rather than diagnostic tests, for which patients would be billed—thereby eliminating coinsurance and deductibles for these services and reducing out-of-pocket costs for Medicare beneficiaries.
