The CY2024 Physician Fee Schedule Final Rule, effective January 1, 2024, includes significant policy changes for Medicare payments under the PFS and other Medicare Part B payment policy issues. The rule includes significant coding and payment changes for services to address HRSNs including Community Health Integration (CHI), Social Determinants of Health (SDOH) Risk Assessment, and Principal Illness Navigation (PIN) services.
There are also provisions to support Medicare providers contracting with community care hubs (CCHs) and community-based organizations (CBOs) to address HRSNs for priority populations. These codes are the first that are specifically designed to describe services involving community health workers, care navigators, and peer support specialists, and that allow these services to be provided by personnel employed by CCHs/CBOs under the general supervision of the billing practitioner.
The Partnership and Freedmen’s Health Consulting are collaborating to develop a series of resources to help stakeholders implement these new billing codes. More information about those resources is below including a recording of a recent webinar event to discuss the recently released report, Understanding the Medicare Physician Fee Schedule Billing Codes for: Community Health Integration (CHI), Principal Illness Navigation (PIN), and Principal Illness Navigation – Peer Support (PIN-PS) Services.
Partnership to Align Social Care Resources:
- (NEW) Understanding the Medicare Physician Fee Schedule Billing Codes for: Community Health Integration (CHI), Principal Illness Navigation (PIN), and Principal Illness Navigation – Peer Support (PIN-PS) Services–A Primer (pdf)
- Webinar: Community Health Integration and Principal Illness Navigation Medicare Codes, April 3, 2024
- Webinar Recording
- Slides (pdf)
- Webinar: The Medicare Physician Fee Schedule (PFS) Includes Codes to Address HRSNs…What Happens Next? November 15, 2023
- Webinar Recording
- Slides (pdf)
Freedmen’s Health Consulting Resources:
- (NEW) Pathways to Payment: https://communityhealthintegration.info/
Administration Resources:
- (NEW) CMS FAQ re: Health Related Social Needs: https://www.cms.gov/files/document/health-related-social-needs-faq.pdf
- CMS Medicare Learning Network Booklet, Health Equity Services in the 2024 Physician Fee Schedule Final Rule
- Link to Final Rule: https://www.federalregister.gov/documents/2023/11/16/2023-24184/medicare-and-medicaid-programs-cy-2024-payment-policies-under-the-physician-fee-schedule-and-other
- CMS PFS Final Rule Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-rule
- Press Release Detailing Efforts to Advance Health Equity: https://www.cms.gov/newsroom/press-releases/cms-finalizes-physician-payment-rule-advances-health-equity
- Press Release Detailing Behavioral Health Care Provisions: https://www.cms.gov/newsroom/press-releases/cms-makes-hospital-prices-more-transparent-and-expands-access-behavioral-health-care