On July 8, the Facilities for Medicare & Medicaid Companies (CMS) filed the 2025 Medicare doctor price schedule and High quality Cost Program proposed rule, which incorporates potential revisions to cost insurance policies beneath the doctor price schedule, high quality cost program and different Medicare Half B cost insurance policies. The AASM well being coverage staff carried out an evaluation of the proposed rule, and the AASM responded to a number of proposals that may doubtlessly influence sleep medication care and reimbursement, if finalized. The AASM submitted a remark letter, in response to the rule, advocating on behalf of all members. A number of key highlights are supplied beneath.
The AASM responded to the next CMS proposals:
8% lower in doctor funds for 2025, with a conversion issue of $32.36
Refinements within the present coverage for providers in 2025 to permit cost of the G2211 complexity add-on code, when the bottom code is reported by the identical practitioner on the identical day as an annual wellness go to, vaccine administration, or every other Half B preventive service within the workplace or outpatient setting
Sustaining and/or extending a number of telehealth flexibilities, initially carried out throughout the COVID-19 public well being emergency
Institution of three new G codes for reporting digital psychological well being remedy
Revisions to MIPS efficiency thresholds
Requests for data (RFI):
Companies related to furnishing oral home equipment used for the remedy of obstructive sleep apnea
Constructing upon the MIPS worth pathways framework to enhance ambulatory specialty care
As CMS critiques all feedback and prepares for publication of the 2025 ultimate rule, AASM will proceed to advocate for members to obtain applicable reimbursement for the supply of high-quality care to sufferers with sleep problems. Members might ship questions concerning the proposed to coding@aasm.org.
