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BREAKING: It’s Official! – Ambulance Add-Ons Extended, 4% Cuts Delayed

Law Extends Add-Ons, Delays PAYGO Cuts, and Continues Telehealth Waivers

Adds-Ons Extended
 The President just signed into law the 2023 Omnibus spending bill, extending the 2% urban, 3% rural and 22.6% super rural Medicare payment add-ons for ground ambulance services through December 31, 2024. 
IMPORTANT NOTE: The current Public Use File posted on the CMS ambulance website has not yet been updated to reflect the urban, rural, and super-rural add-on extensions (the file is dated 11/23/2022, prior to the add-ons being included).  We strongly encourage EMS agencies and billing companies to ensure their Medicare Administrative Contractor (MAC) has implemented the updated rates – including the add-ons – before submitting claims for dates of service (DOS) 1/1/2023 or after.  There have been issues in the past where MACs paid at the incorrect rates and then the MACs took months to correct the improper payments.  It is also possible that CMS – in the next few days – may instruct MACs to hold off paying ambulance claims with DOS in 2023 until the rates have been updated to avoid incorrect payments.   Stay tuned for updates.

Medicare 4% PAYGO Cuts Delayed
The Act also delays, until 2025, a 4% Medicare cut under the Statutory Pay-As-You -Go Act of 2010 (PAYGO).  The 4% cut was set to go into effect on January 1, 2023. 

Telehealth Waivers Extended  

The Act also extends – until December 31, 2024 – many of the telehealth reimbursement waivers/flexibilities enacted in response to the COVID-19 pandemic.  Under current law, many of these flexibilities were set to expire 151 days after the end of the COVID-19 PHE.

Most importantly for EMS, the telehealth flexibilities permit any site (including a patient’s home or a scene of an incident) to be a telehealth origination site for the service.  Prior to the waiver, telehealth services generally had to originate in a rural area, and the patient had to connect from an approved origination site – such as a physician’s office, hospital, or clinic.  While there is no direct Medicare reimbursement for telehealth for EMS right now, EMS can originate telehealth consultations for practitioners in the field and contract with eligible practitioners for a portion of the telehealth consultation fee paid to the practitioner.
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