Big Changes Coming to Medicare in 2024 for Addiction Treatment

Major changes are coming to the Medicare program for Addiction Specialist Physicians (ASPs) and other practitioners treating addiction in 2024. On July 13th, the Centers for Medicare and Medicaid Services (CMS) released the annual Medicare Physician Fee Schedule (MPFS). This major rule details the annual payment policies that CMS plans to implement in the following year.

Here are the big takeaways:

• The Addiction Medicine specialty is poised to see a 2.93% positive adjustment in allowable Medicare payments;
• Marriage & Family Therapists and Mental Health Counselors are now covered Medicare providers beginning in 2024;
• Medicare will begin paying for mobile crisis services;
• CMS is proposing to apply a positive payment adjustment for psychotherapy services over a 4-year period (about 19% total);
• A substantial increase in payment for G2086 (office-based treatment of substance use disorder, first month) and G2087 (office-based treatment of substance use disorder, subsequent months);
• New services to address determinants of health, principle illness navigation services, and community health integration services; and
• CMS will continue to allow periodic assessments (HCPCS code G2077) to be provided via audio-only technology for the duration of 2024.

In good news for the expansion of the care continuum, CMS is also implementing new coverage and payment for intensive outpatient services (IOP) beginning in 2024 for settings that include Community Mental Health Centers (CMHC), Federally-Qualified Health Centers (FQHCs), Rural Health Centers (RHCs), and Opioid Treatment Programs (OTPs). The implementation of this coverage in Medicare will close one of the existing gaps in the care continuum. There continues to be a lack of coverage under Medicare for residential addiction treatment. Furthermore, unfortunately, the rule also continues a lack of coverage under Medicare for standalone IOP programs offered outside of these settings.

In terms of telehealth, for services provided to patients in their homes, CMS will continue to pay the non-facility rate (higher rate) for these claims. Telehealth services provided in locations other than a patient’s home will be paid at the facility rate (lower rate). Additionally, a patient’s home may continue to serve as an originating site for mental health telehealth services until December 31, 2024. Beginning in 2025, for Medicare mental health telehealth services, patients must have an in-person visit at least 6 months prior to the telehealth visit and within 6 months after any subsequent telehealth visit. This extension will also apply to FQHCs and RHCs. Telehealth services provided for the treatment of a substance use disorder (SUD) are not implicated here as statute provides separate coverage.

CMS is also looking for feedback on additional opportunities for CMS to expand Medicare coverage to treat behavioral health conditions and SUD, as well as information related to digital therapeutics.

For a detailed analysis, click here.

Comments on the proposed rule are due September 11^th; ASAM’s comments will be posted to the website.