On Wednesday, the Centers for Medicare & Medicaid Services (CMS) released its proposed calendar year 2025 physician fee schedule, which includes recommendations on coverage of digital health tools, including digital therapeutics and telehealth services. 

To support access to behavioral health services, CMS proposed that Medicare pay for digital mental health treatment devices used in conjunction with a behavioral health treatment plan. 

“We are proposing to create three new HCPCS codes and we would monitor how digital mental health treatment devices are used as part of overall behavioral health care,” according to the agency’s statement.  

“We are also proposing to create six G codes to be billed by practitioners in specialties whose covered services are limited by statute to services for the diagnosis and treatment of mental illness (including clinical psychologists, clinical social workers, marriage and family therapists, and mental health counselors) to mirror current interprofessional consultation CPT codes used by practitioners who are eligible to bill E/M visits.”

CMS also proposed adding new services to the telehealth services list, including telehealth for caregiver training, opioid use disorder treatment, and audio-only telehealth services if a patient is incapable of using video services or does not consent to video. 

The agency also proposed continued coverage of telehealth services introduced during the COVID-19 pandemic; however, those services are set to expire at the end of this year. Congress will need to extend coverage for them to remain in effect. 

The draft PFS is under a 60-day comment period, expiring on September 9.

THE LARGER TREND

Another aspect of the PFS is a proposal for reducing physician payments by 2.93% in 2025, as reported by MobiHealthNews sister publication Healthcare Finance News. 

In response to the proposal, the president of the American Medical Association said, “The death by a thousand cuts continues.”

The decrease contrasts with the 2.6% increase in Medicare reimbursement for hospital outpatient departments next year.