CMS Issues Final 2024 Medicare Physician Fee Schedule, Includes Dental and Oral Health Policy Changes

The Centers for Medicare & Medicaid Services (CMS) has released the 2024 Medicare Physician Fee Schedule Final Rule, which is a complete listing of fees used by Medicare to pay doctors or other providers and suppliers. This comprehensive listing of fee maximums, which also contains policy changes for the upcoming year, is used to reimburse a physician and/or other providers on a fee-for-service basis. The fee schedule is effective on or after Jan. 1, 2024.

Last year, CMS statutorily established that “Medicare payment under Parts A and B could be made when dental services are furnished in either the inpatient or outpatient setting under particular kinds of circumstances.” Specifically, the dental services had to be “inextricably linked to other covered medical services, such as dental exams and necessary treatments prior to organ transplants (including stem cell and bone marrow transplants), cardiac valve replacements, and valvuloplasty procedures."

For the upcoming fiscal year 2024, CMS has done the following:

1. It has codified the previously finalized payment policy for dental services for head and neck cancer treatments, whether primary or metastatic.
2. It has codified allowing Medicare Part A and Part B payment for dental or oral examination performed as part of a comprehensive workup prior to medically necessary diagnostic and treatment services, to eliminate an oral or dental infection prior to, or contemporaneously with, those treatment services, and to address dental or oral complications after radiation, chemotherapy and/or surgery when used in the treatment of head and neck cancer.
3. It has finalized its proposal to permit payment for certain dental services inextricably linked to other covered services used to treat cancer prior to, or during:
1. Chemotherapy services,
2. Chimeric Antigen Receptor T- (CAR-T) Cell therapy or
3. The use of high-dose bone modifying agents (antiresorptive therapy).

The rule includes assurances that Medicare will pay the same rate for telehealth services delivered at home as those delivered in a doctor’s office, delays requirements that patients visit a doctor in-person within six months prior to starting mental health services online and continues to allow teaching physicians to bill Medicare if they use telehealth to supervise a resident performing care.

The rule also allows physicians to continue using their office address for telehealth claims, rather than listing their home address. This protects provider privacy and removes a barrier to delivering telehealth for clinicians working from home.