LPC AND MENTAL HEALTH COUNSELERS ADDED TO MEDICARE 2024!

As of 1/1/2024, Medicare will now accept par status for Mental health counselors and LPCs! Be sure to get your credentialing files in on time.

SOURCE: https://www.nbcc.org/govtaffairs/medicare

After more than a decade of working to secure Medicare coverage for counselors’ services, NBCC, the Medicare Mental Health Workforce Coalition, and counselors across the country can celebrate the passing of the omnibus package, which achieved our goal! The package, which includes language from the Mental Health Access Improvement Act (S. 828/H.R. 432) that expands coverage of mental health counselors (MHCs) and marriage and family therapists (MFTs) under Medicare Part B, was signed into law by President Biden on Dec. 29, 2022.

Coverage of MHCs and MFTs under Part B of the Medicare program will begin Jan. 1, 2024. Medicare is the largest health care program in the country, covering more than 55 million people. It currently recognizes psychiatrists, psychologists, clinical social workers, and psychiatric nurses for outpatient mental health services, and now counselors and MFTs will be added to the list. Because Medicare is the country’s flagship health care program, counselor inclusion is key to ensuring parity with other professions.

Chiropractic - Medicare Coverage Modernization Act

Dear Chiropractors,

As many of you now, there is a bill working its way through the chain to update and include more Medicare approved services for Chiropractors.

You may read more about this new bill here: https://www.congress.gov/bill/118th-congress/senate-bill/799/actions

You may voice your support for this new bill here or scan the QR code: https://www.votervoice.net/mobile/ACA/campaigns

MEDICARE TO REQUIRE PRIOR AUTH ON DME ITEMS

Please be aware for all Medicare DME Approved suppliers that the prior authorization list for Medicare is updating.


THIS DIRECTLY AFFECTS US THIS YEAR


Many orthosis items are now on the prior auth list, specifically common items such as:

E0748

E0746

L0631

L0637

L0648

L0650

L1005

L1832

L1834

L1845


The requirements for prior auth will be released in phases. Please locate your state to determine when you are affected.


Orthoses Requirements
CMS selected five HCPCS codes (L0648, L0650, L1832, L1833, and L1851) subject to required prior authorization. Implementation of this requirement will be completed in three phases.

Phase one begins April 13, 2022 in New York, Illinois, Florida, and California. Phase two begins July 12, 2022 in Maryland, Pennsylvania, New Jersey Michigan, Ohio, Kentucky, Texas, North Carolina, Georgia, Missouri, Arizona, and Washington.

Phase three begins October 10, 2022 in all remaining states and territories not included in phase 1 or phase 2.


You can read more here: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/DMEPOS/Prior-Authorization-Process-for-Certain-Durable-Medical-Equipment-Prosthetic-Orthotics-Supplies-Items


I also attached the entire prior auth list.


If you are part of Triple B's auth program, please remember to request prior auth PRIOR to delivering items so that we may obtain.


If you obtain your own auths, please remember to request prior auth PRIOR to delivering items and provide the auth approval number on the fee slip.


We will send out reminders close to each state release date.


Thank you

NEW ICD 10 CODES FOR 2021

New codes are coming! While there are many changes each year, some are very common and close to home.


Please heed some of these notable changes below.


More details will follow in the coming weeks.
New codes for Pain/Chiro/PT providers:The current code, M54.5 (Low back pain), will be expanded into three more specific codes: You will no longer be able to use M54.5, you must further specify below.

M54.50 (Low back pain, unspecified)
M54.51 (Vertebrogenic low back pain)
M54.59 (Other low back pain)


New codes for PCP/Internal Providers:
The current code, R05 (Cough) will expand into more specific codes: You will no longer be able to use R05, you must further specify below.

R05.1 (Acute cough)
R05.2 (Subacute cough)
R05.3 (Chronic cough)
R05.4 (Cough syncope)
R05.8 (Other specified cough)
R05.9 (Cough, unspecified)

New codes for Behavioral Health providers:

F32.A Depression, unspecified under revised category F32 Depressive episode


New codes for SNF/Hospital providers:

Three new codes are added to Chapter 11 to classify esophageal diseases:

K22.1 Esophageal polyp
K22.82 Esophagogastric junction polyp
K22.89 Other specified disease of esophagus (hemorrhage of the esophagus NOS)

Updates for OBGYN

The addenda do not show any changes for Chapter 14: Diseases of the genitourinary system or Chapter 15: Pregnancy, childbirth and the puerperium, but Chapter 16 has nine new codes: one code for newborn affected by maternal group B Streptococcus colonization and eight codes to capture specific abnormal findings on neonatal screening.

Pediatric, ST and OT providers:

4 new codes

R63.30 Feeding difficulties, unspecified
R63.31 Pediatric feeding disorder, acute
R63.32 Pediatric feeding disorder, chronic
R63.39 Other feeding difficulties (feeding problem (elderly) (infant) NOS, picky eater)

E&M Major Code changes for 2021

Providers,

Last year, there was talk that the entire E&M basis was going to be changed in the future.  At that time, they decided to eliminate all levels of office visits and encompass all payment under one level.  Providers obviously were dismayed at this option.

The AMA fought this and a new set of proposed rules is set to be active for 2021 with E&M coding.

Please find information on the new E&M code sets attached.

I will release new  information as items develop and change. 

Some highlights:

  • 99201 will be deleted

  • You may use TIME or MEDICAL DECISION MAKING for the basis on selecting a code level

  • PFSH History or Exam will no longer be required

“Office or other outpatient services include a medically appropriate history and/or physical examination, when performed. The nature and extent of the history and/or physical examination is determined by the treating physician or other qualified health care professional reporting the service. The care team may collect information and the patient or caregiver may supply information directly (eg, by portal or questionnaire) that is reviewed by the reporting physician or other qualified health care professional. The extent of history and physical examination is not an element in selection of office or other outpatient services.”

Find more info here: E&M Major Code changes for 2021

New Code Accounts for Certain Additional Expenses During Public Health Emergencies

Providers,

Due to the Covid national emergency, a new CPT has emerged to help offset expenses for additional sanitary requirements needed.

99072     Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease

86413     Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative

Please find more information here: https://www.ama-assn.org/press-center/press-releases/ama-announces-new-cpt-codes-covid-19-advancements-expand
Please add this code to your superbill when applicable and appropriate.Thank  you 

DEA ALLOWS FOR OPIOID MEDICATION MANAGEMENT VIA TELEHEALTH

Please follow the below link. The DEA has released a letter stating they will allow for pain management providers to perform medication management for scheduled class drugs during the national state of emergency.

https://www.deadiversion.usdoj.gov/GDP/(DEA-DC-015)%20SAMHSA%20Exemption%20NTP%20Deliveries%20(CoronaVirus).pdf

https://www.deadiversion.usdoj.gov/coronavirus.html