[Federal Register Volume 90, Number 155 (Thursday, August 14, 2025)]
[Proposed Rules]
[Pages 39155-39161]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2025-15492]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 405, 410, 414, 424, 425, 427, 428, 495, and 512
[CMS-1832-CN]
RIN 0938-AV50
Medicare and Medicaid Programs; CY 2026 Payment Policies Under
the Physician Fee Schedule and Other Changes to Part B Payment and
Coverage Policies; Medicare Shared Savings Program Requirements; and
Medicare Prescription Drug Inflation Rebate Program; Correction
AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of
Health and Human Services (HHS).
ACTION: Proposed rule; correction.
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SUMMARY: This document corrects typographical and technical errors in
the proposed rule that appeared in the July 16, 2025 Federal Register
(90 FR
[[Page 39156]]
32352) titled ``Medicare and Medicaid Programs; CY 2026 Payment
Policies Under the Physician Fee Schedule and Other Changes to Part B
Payment and Coverage Policies; Medicare Shared Savings Program
Requirements; and Medicare Prescription Drug Inflation Rebate Program''
(hereinafter referred to as the CY 2026 PFS proposed rule), specifying
proposed changes to the Medicare physician fee schedule (PFS) that is
applicable for calendar year (CY) 2026, and other changes to Medicare
Part B payment policies, as well as proposals regarding other Medicare
payment policies.
DATES: To be assured consideration, comments must be received at one of
the addresses provided below, no later than 5 p.m. on September 12,
2025.
ADDRESSES: In commenting, please refer to file code CMS-1832-P.
Comments, including mass comment submissions, must be submitted in
one of the following three ways (please choose only one of the ways
listed):
1. Electronically. You may submit electronic comments on this
regulation to http://www.regulations.gov. Follow the ``Submit a
comment'' instructions.
2. By regular mail. You may mail written comments to the following
address ONLY: Centers for Medicare & Medicaid Services, Department of
Health and Human Services, Attention: CMS-1832-P, P.O. Box 8016,
Baltimore, MD 21244-8016.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments to
the following address ONLY: Centers for Medicare & Medicaid Services,
Department of Health and Human Services, Attention: CMS-1832-P, Mail
Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
FOR FURTHER INFORMATION CONTACT:
[email protected], for any issues not
identified below. Please indicate the specific issue in the subject
line of the email. For all questions related to reporting a service on
a claim, please contact your Medicare Administrative Contractor.
Michael Soracoe, Morgan Kitzmiller, or
[email protected], for issues related to
practice expense, work RVUs, conversion factor, and PFS specialty-
specific impacts.
Hannah Ahn, or [email protected], for issues
related to potentially misvalued services under the PFS.
Pamela West, or [email protected], for
issues related to outpatient therapy services and KX modifier
thresholds.
Janae James, (410) 786-0801, or [email protected],
for issues related to the Medicare Shared Savings Program.
Amy Gruber, (410) 786-1542, for issues related to Ambulance
Extender provisions.
Kati Moore, (410) 786-5471, for inquiries related to the Merit-
based Incentive Payment System (MIPS) track of the Quality Payment
Program (QPP).
Trevey Davis, (667) 290-8527, for inquiries related to the Advanced
Alternative Payment Models (APMs) track of QPP.
Laura Kennedy, (410) 786-3377, Rebecca Ray, (667) 414-0879, and Jae
Ryu, (667) 414-0765 for issues related to Drugs and Biological Products
Paid Under Medicare Part B.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2025-13271 of July 16, 2025, the CY 2026 PFS proposed
rule (90 FR 32352), there were typographical and technical errors that
are identified and corrected in this correcting document.
II. Summary of Errors
A. Summary of Errors in the Preamble
On page 32352, we inadvertently made a typographical error.
On page 32353, we inadvertently included an incorrect Summary of
the Key Provisions.
On page 32386, we inadvertently omitted a potentially misvalued
code nomination.
On page 32503, we inadvertently omitted the section titled
Outpatient Therapy Services and KX Modifier Thresholds from the
proposed rule.
On page 32637, we inadvertently included language related to the
transfer of labeler codes.
On page 32671, we inadvertently included an incorrect reference in
footnote 323.
On page 32717, we inadvertently made a technical error in the
number of proposed substantive changes.
On page 32770, we inadvertently included an incomplete sentence.
On page 32771, we inadvertently included a typographical error.
On page 32776, we inadvertently made a technical error in a table
reference.
On page 32777, we inadvertently included language that reflected
the standard non-rule PRA process.
On page 32778, we made an inadvertent typographical error in a
section reference.
On page 32779, we inadvertently made a typographical error.
On page 32781, we inadvertently omitted text preceding table `Table
82: TABLE 82: Annual Responses Beginning with the CY 2027 Performance
Period/2029 MIPS Payment Year Under OMB Control Number 0938-1222 (CMS-
10450).
On page 32793, we inadvertently referenced a regulatory citation
and made technical errors in Table 87: Proposed Annual Requirements and
Burden Estimates.
On page 32799, we inadvertently made two typographical errors.
On page 32801, in Tables 89, 90, and 91, the CY 2026 RVU Budget
Neutrality Adjustment we inadvertently made typographical errors in the
conversion factors.
On page 32818, we made an inadvertent typographical error in a
section reference.
On page 32834, we inadvertently omitted a section heading.
B. Summary of Errors in the Regulations Text
On page 32850, we inadvertently omitted regulation text changes to
a definition in Sec. 414.1305 and made formatting and paragraph
designation errors in Sec. 414.1380.
On page 32851, we made technical errors in Sec.
414.1400(d)(3)(vi)(A).
C. Summary of Errors in Appendices
On page 33162, under Table DD.2 Colorectal Cancer Screening, we
inadvertently made a typographical error in the Substantive Change row.
On page 33183, we inadvertently made a typographical error in
omitting the asterisk (*) key after ``Symbol Key:''
On page 33208 in Table B.2, we inadvertently omitted quality
measure Q144: Oncology: Medical and Radiation, Plan of Care for Pain
under the Advancing Cancer Care MVP, the Radiation Oncology Clinical
Grouping.
On page 33219, we made inadvertent errors in the list of
Improvement Activities included in the Coordinating Stroke Care to
Promote Prevention and Cultivate Positive Outcomes MVP.
On page 33255, we inadvertently repeated several paragraphs.
III. Waiver of the 60-Day Public Comment Period
Under section 553(b) of the Administrative Procedure Act (the APA)
(5 U.S.C. 553(b)), the agency is required to publish a notice of
proposed rulemaking in the Federal Register
[[Page 39157]]
before the provisions of a rule take effect. Similarly, section
1871(b)(1) of the Social Security Act (the Act) requires the Secretary
to provide for notice of the proposed rule in the Federal Register and
provide a period of not less than 60 days for public comment. Section
553(b)(B) of the APA provides for exceptions from the APA notice and
comment requirements; in cases in which these exceptions apply, section
1871(b)(2)(C) of the Act provides exceptions from the notice and 60-day
comment period requirements of the Act as well. Section 553(b)(B) of
the APA and section 1871(b)(2)(C) of the Act authorize an agency to
dispense with normal notice and comment rulemaking procedures for good
cause if the agency makes a finding that the notice and comment process
is impracticable, unnecessary, or contrary to the public interest, and
includes a statement of the finding and the reasons for it in the rule.
In our view, this correcting document does not constitute a rulemaking
that would be subject to these requirements. The corrections made
through this correcting document are intended to resolve inadvertent
errors so that the CY 2026 PFS proposed rule accurately reflects the
policies proposed therein.
In addition, even if this were a rulemaking to which the notice and
comment requirements applied, we find that there is good cause to waive
such requirements. The 60-day comment period referenced in section
1871(b)(1) of the Act may be shortened, as provided under section
1871(b)(2)(C) of the Act, when the Secretary finds good cause that a
60-day comment period would be impracticable, unnecessary, or contrary
to the public interest and incorporates a statement of the finding and
its reasons in the rule issued. For this proposed rule correcting
document, we are waiving the 60-day comment period for good cause and
allowing a comment period that coincides with the comment period
provided for the CY 2026 PFS proposed rule. Undertaking further notice
and comment procedures to incorporate the corrections in this document
into the CY 2026 PFS proposed rule would be contrary to the public
interest because a full 60-day comment period would end on a date that
would not allow the agency sufficient time to process the comments and
respond to them in a meaningful manner by the November 1, 2025 date for
issuing the final rule. If we allowed for a full 60-day comment period,
timely filed comments would receive a shorter period of time for
consideration by the agency, and the agency would be left with
insufficient time to properly respond to comments and appropriately
resolve whether any of the proposed policies should be modified in
light of comments received. For all of these reasons, we find good
cause to waive the 60-day comment period for this proposed rule
correcting document, and we are instead providing for a comment period
that coincides with the comment period provided for the CY 2026 PFS
proposed rule that appeared in the July 16, 2025 Federal Register.
IV. Correction of Errors
In FR Doc. 2025-13271 of July 16, 2025 (90 FR 32352), make the
following corrections:
A. Correction of Errors in the Preamble
On page 32352, first column, first full paragraph, line 21, the
phrase ``Qualified Health Centers update to the'' is corrected to read
``Qualified Health Centers; update to the''.
2. On page 32353, third column, nineth bulleted paragraph, the
phrase ``Access to Behavioral Health Services (section II.I.)'' is
corrected to read ``Policies to Improve Care for Chronic Illness and
Behavioral Health Needs (section II.I.)''.
3. On page 32386, third column, following the first full paragraph,
the text is corrected by adding the following:
``(12) Sleep Study (CPT code 95800)
For CY 2026, an interested party re-nominated CPT code 95800 (Sleep
study, unattended, simultaneous recording; heart rate, oxygen
saturation, respiratory analysis (e.g., by airflow or peripheral
arterial tone, and sleep time). This code was recently nominated two
times as potentially misvalued in the CY 2024 PFS proposed rule (88 FR
52283 through 52284) and the CY 2025 PFS proposed rule (89 FR 61618
through 61619).
For the CY 2024 and CY 2025 PFS final rules, we stated that we were
unable to properly assess whether CPT code 95800 is potentially
misvalued and further stated that we could not identify whether
disposable or reusable home sleep apnea testing (HSAT) devices are more
commonly used based on the evidence submitted with the original
nominations and subsequent comments that CMS received. To confirm
whether disposable devices were more commonly used, the nominator
commissioned a consulting group to conduct an independent survey of
sleep medicine providers, developed with input from the American
Academy of Sleep Medicine (AASM), which found that 60 percent of
procedures reported with CPT code 95800 used fully disposable HSAT
equipment among respondents who reported this service in 2023.
The nominator stated that CPT code 95800 is misvalued because there
has been a fundamental shift in clinical practice from reusable
equipment to disposable HSAT devices, but the current direct practice
expense (PE) inputs still reflect the older reusable technology
assumptions. The nominator stated that CMS currently models' payment
for CPT code 95800 based on the use of a reusable sleep testing device
(the WatchPAT 200) with a consumable component (WatchPAT probe), but
the survey data demonstrates that the majority of procedures now use
fully disposable devices like the WatchPAT ONE. According to the
nominator, this misalignment between current medical practice and the
direct PE inputs has resulted in inaccurate direct practice expenses
for CPT code 95800 and created access challenges for Medicare
beneficiaries, particularly in rural and remote areas, since the
payment structure does not accurately reflect the actual costs and
technologies used in contemporary sleep study practices. The nominator
recommended deleting the current equipment codes for reusable devices
and adding a new supply code for the disposable WatchPAT ONE device to
ensure that Medicare reimbursement rates align with the ``typical
procedure'' methodology that now involves disposable rather than
reusable equipment. For more details, we refer to the CY 2025 PFS final
rule (89 FR 97741 through 97743). Also, we refer readers to the
submitted nomination, which is posted in the public use files for this
proposed rule available on our public website under PFS Federal
Regulation Notices at https://www.cms.gov/medicare/payment/fee-schedules/physician/federal-regulation-notices.
While we appreciate the survey, we note that there are several
limitations that can influence the survey's generalizability, validity,
and reliability. Some key limitations include a small sample of 25
complete responses with a low 12 percent survey engagement rate, and
methodological constraints such as the short 17-day survey period.
Given that we only have access to the nominator's summary of their
internal data and survey results with a few notable limitations, we
propose to maintain the current direct PE supply and equipment inputs
for CPT code 95800. We are not proposing to nominate the code as
potentially misvalued. We welcome public comments, published studies,
other surveys, and data on whether the typical
[[Page 39158]]
procedure described by CPT code 95800 now involves the use of a
disposable HSAT device rather than reusable equipment.''.
4. On page 32503, first column before the first paragraph, the
language is corrected by adding the following:
``H. Outpatient Therapy Services and KX Modifier Thresholds
1. Technical Correction (Sec. 410.62(a))
In the CY 2009 PFS final rule (73 FR 69874 through 69875) we
finalized the addition of a new paragraph at Sec. 410.62(c) for the
services of speech-language pathologists (SLPs) in private practice
(SLPPPs) allowed through the amendments in section 143 of the Medicare
Improvement for Patients and Providers Act of 2008 (MIPPA); and, we
also finalized a new condition of payment at Sec. 410.62(a)(3)(ii)
requiring these SLPPPs to meet the qualifications of SLPs at 42 CFR
part 484 that is specified in the basic rule for outpatient speech-
language pathology services at Sec. 410.62(a).
During a recent review of our regulations at Sec. Sec. 410.62, we
noticed an error in Sec. 410.62(a). That is, the basic rule at Sec.
410.62(a) does not correctly reflect the policy that for Medicare Part
B to pay for outpatient speech-language pathology services, those
services are required to be delivered only by SLPs--including the
SLPPPs specified at paragraph (a)(3)(ii)--meeting the requirements for
an SLP at Sec. 484.115. Instead, Sec. 410.62(a) states that ``Except
as specified in paragraph (a)(3)(ii) of this section'' rather than
paragraph (a)(3)(iii) which was paragraph (a)(3)(ii) before being
repositioned to paragraph (a)(3)(iii) when the condition of payment was
added for the services of SLPPPs. We inadvertently did not update the
exception paragraph during CY 2009 PFS rulemaking to reflect the
correct policy under which the individual furnishing services incident
to the services of physicians, physician assistants (PAs), clinical
nurse specialists (CNSs), or nurse practitioner (NPs) does not have to
meet the state licensure requirement at Sec. 484.115 (although they
are required to meet the other standards and conditions that apply to
SLPs). Therefore, we propose to revise Sec. 410.62(a) to reflect the
policy related to qualifications for individuals furnishing services
incident to the services of physicians, PAs, CNSs, and NPs by correctly
referencing paragraph (a)(3)(iii) in place of paragraph (a)(3)(ii). We
are also proposing to make a conforming regulatory change at Sec.
410.26(c)(2) to refer readers to Sec. 410.62(a)(3)(iii) instead of
Sec. 410.62(a)(3)(ii) for the correct policy related to the
qualifications for individuals providing speech-language pathology
services furnished incident to the services of physicians, PAs, CNSs,
and NPs.
2. KX Modifier Thresholds
The KX modifier thresholds were established through section 50202
of the Bipartisan Budget Act of 2018 (Pub. L. 115-123, February 9,
2018) (BBA) and were formerly referred to as the therapy cap amounts.
These per-beneficiary amounts under section 1833(g) of the Act (as
amended by section 4541 of the Balanced Budget Act of 1997) (Pub. L.
105-33, August 5, 1997) are updated each year based on the percentage
increase in the Medicare Economic Index (MEI). Specifically, these
amounts are calculated by updating the previous year's amount by the
percentage increase in the MEI for the upcoming calendar year and
rounding to the nearest $10.00. Thus, for CY 2026, we propose to
increase the CY 2025 KX modifier threshold amount by the most recent
forecast of the 2017-based MEI. For CY 2026, the proposed MEI increase
is estimated to be 2.7 percent and is based on the expected historical
percentage increase of the 2017-based MEI. Multiplying the CY 2025 KX
modifier threshold amount of $2,410 by the proposed CY 2026 percentage
increase in the MEI of 2.7 percent ($2,410 x 1.027) and rounding to the
nearest $10.00 results in a proposed CY 2026 KX modifier threshold
amount of $2,480 for physical therapy and speech-language pathology
services combined and $2,480 for occupational therapy services. We also
propose to update the MEI increase for CY 2026 based on historical data
through the second quarter of 2025, and we propose to use such data, if
appropriate, to determine the final MEI percentage increase and the CY
2026 KX modifier threshold amounts in the CY 2026 PFS final rule.
Section 1833(g)(7)(B) of the Act describes the targeted medical
review (MR) process for services of physical therapy, speech-language
pathology, and occupational therapy services. The threshold for
targeted MR is $3,000 through CY 2027. Effective beginning with CY
2028, the MR threshold levels will be annually updated by the
percentage increase in the MEI, per section 1833(g)(7)(B) of the Act.
Consequently, for CY 2026, the MR threshold is $3,000 for physical
therapy and speech-language pathology services combined and $3,000 for
occupational therapy services. Section 1833(g)(5)(E) of the Act states
that CMS shall identify and conduct targeted medical review using
factors that may include the following:
The therapy provider has had a high claims denial
percentage for therapy services under this part or is less compliant
with applicable requirements under this title.
The therapy provider has a billing pattern for therapy
services under this part that is aberrant compared to peers or
otherwise has questionable billing practices for such services, such as
billing medically unlikely units of services in a day.
The therapy provider is newly enrolled under this title or
has not previously furnished therapy services under this part.
The services are furnished to treat a type of medical
condition.
The therapy provider is part of a group that includes
another therapy provider identified using the factors described
previously in this section.
We track each beneficiary's incurred expenses for therapy services
annually and count them towards the KX modifier and MR thresholds by
applying the PFS rate for each service less any applicable multiple
procedure payment reduction (MPPR) amount for services of CMS-
designated ``always therapy'' services (see the CY 2011 PFS final rule
at 75 FR 73236). We also track therapy services furnished by critical
access hospitals (CAHs), applying the same PFS-rate accrual process,
even though they are not paid for their therapy services under the PFS
and may be paid on a cost basis (effective January 1, 2014) (see the CY
2014 PFS final rule at 78 FR 74406 through 74410).
When the beneficiary's incurred expenses for the year for
outpatient therapy services exceed one or both of the KX modifier
thresholds, therapy suppliers and providers use the KX modifier on
claims for subsequent medically necessary services. Using the KX
modifier, the therapist and therapy provider attest that the services
above the KX modifier thresholds are reasonable and necessary and that
documentation of the medical necessity for the services is in the
beneficiary's medical record. Claims for outpatient therapy services
exceeding the KX modifier thresholds without the KX modifier included
are denied.''.
5. On page 32637, second column, first partial paragraph, lines 10
through 12, the phrase ``information (see also section III.E.2.a. of
this proposed rule regarding transfer of labeler codes); and'' is
corrected to read ``information; and''.
6. On page 32671, first column, first footnote paragraph (footnote
323), line 1 through 5, the sentence ``Refer to
[[Page 39159]]
Executive Order 14192 ``Unleashing Prosperity Through Deregulation''
https://www.federalregister.gov/documents/2025/02/06/2025-02345/
unleashing-prosperity-through-deregulation'' is corrected to read ``See
discussion on use of our authority under section 1899(i)(3) of the Act,
at 87 FR 69950.''.
7. On page 32717,
a. Second column, last paragraph, line 3, the phrase ``42 MIPS
quality measures.'' is corrected to read ``32 MIPS quality measures.''.
b. Third column, third bulleted paragraph, line 1, the phrase ``42
MIPS'' is corrected to read ``32 MIPS''.
8. On page 32770, lower two-thirds of the page, second column,
first partial paragraph, last line, the sentence ``In the
414.1425(d).'' is corrected by removing the sentence.
9. On page 32771, first column, last partial paragraph, lines 1 and
2, the phrase ``a conforming revision at Sec. 414.1425(c)(3)(i)'' is
corrected to read ``conforming revisions at Sec. 414.1425(c)(3)(i) and
(4)''.
10. On page 32776, third column, third full paragraph, line 1, the
reference ``Table 73'' is corrected to read ``Table 74''.
11. On page 32777, upper half of the page, first column, first
paragraph, lines 1 through 14, the sentences ``Pending our finalization
of the following proposed provisions, the changes will submitted to OMB
for review and approval under control number 0938-0921 (CMS-10110)
using the standard PRA process. The process includes the publication of
60- and 30-day Federal Register notices that will provide the public
with additional opportunities to review and comment on the changes. The
following proposed changes will be submitted to OMB for review under
control number 0938-0921 (CMS-10110).'' are corrected to read ``The
following proposed changes will be submitted to OMB for review under
control number 0938-0921 (CMS-10110).''.
12. On page 32778, lower third of the page, first column, last
paragraph, line 8, the reference ``section VII.E.'' is corrected to
read ``section VII.''.
13. On page 32779, third column, partial paragraph, line 44, the
phrase ``component'' is corrected to read ``component''.
14. On page 32781, middle of the page, after the table notes for
TABLE 81 and before the table titled ``TABLE 82: ANNUAL RESPONSES
BEGINNING WITH THE CY 2027 PERFORMANCE PERIOD/2029 MIPS PAYMENT YEAR
UNDER OMB CONTROL NUMBER 0938-1222 (CMS-10450)'' the language is
corrected by adding the following:
``For the Consumer Assessment of Healthcare Providers and Systems
(CAHPS) for MIPS Survey ICRs under OMB control number 0938-1222 (CMS-
10450) (see section V.B.5.b.(1) of this proposed rule), we estimate
that the policy proposals in this proposed rule would result in an
annual change of 0 responses, +10 hours, and +$1,077 (see total of
Total Change in Tables 82, 83, and 84, respectively), beginning with
the CY 2027 performance period/2029 MIPS payment year.''.
15. On page 32793, lower half of the page, in the table titled
``TABLE 87: PROPOSED ANNUAL REQUIREMENTS AND BURDEN ESTIMATES'', the
sixth and seventh rows are corrected to read as follows:
Table 87--Proposed Annual Requirements and Burden Estimates
--------------------------------------------------------------------------------------------------------------------------------------------------------
Section(s) under
title 42 of the OMB control number No. respondents Total annual Time per response Total annual time Labor cost ($/hr) Total cost ($)
CFR (CMS ID No.) responses (hours) (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Medicare 0938-TBD (CMS- 6,500 Covered 26,000 Covered 8 Covered 208,000 Covered Varies 23,195,120
Prescription Drug 10930) Entities or TPAs Entities or TPAs Entities or TPAs Entities or TPAs Covered Entities
Inflation Rebate or TPAs
Program under
Sections 11101
and 11102 of the
Inflation
Reduction Act
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total n/a 64,683 91,667 varies 197,909 varies 22,698,711
--------------------------------------------------------------------------------------------------------------------------------------------------------
16. On page 32799,
a. Second column, last full paragraph, line 1, the reference
``section III.H.'' is corrected to read ``section III.G.''.
b. Third column, third full paragraph, line 4, the phrase ``ased on
our'' is corrected to read ``Based on our''.
17. On page 32801,
a. Top half of the page in the table titled ``TABLE 89: CALCULATION
OF THE CY 2026 PFS NON-QUALIFYING APM CONVERSION FACTOR, THE CY 2026
RVU BUDGET NEUTRALITY ADJUSTMENT'', third row, second column the entry
``0.55 percent (1.0045)'' is corrected to read ``0.55 percent
(1.0055)''.
b. Middle of the page, in the table titled ``TABLE 90: CALCULATION
OF THE CY 2026 ANESTHESIA QUALIFYING APM CONVERSION FACTOR, THE CY 2026
RVU BUDGET NEUTRALITY ADJUSTMENT third row, second column the entry
``0.55 percent (1.0045)'' is corrected to read ``0.55 percent
(1.0055)''.
c. Lower one-half of the page, in the table titled ``TABLE 91:
CALCULATION OF THE CY 2026 ANESTHESIA NON-QUALIFYING APM CONVERSION
FACTOR, THE CY 2026 RVU BUDGET NEUTRALITY ADJUSTMENT'' third row,
second column the entry ``0.55 percent (1.0045)'' is corrected to read
``0.55 percent (1.0055)''.
18. On page 32818, first column, last partial paragraph, line 1,
the reference ``section III.H.'' is corrected to read ``section
III.G.''.
19. On page 32834, second column, first full paragraph, line 1, the
phrase ``In our MIPs eligible clinician'' is corrected to read as
follows:
``f. Assumptions & Limitations
In our MIPS eligible clinician''.
B. Correction of Errors in the Regulations Text
0
20. On page 32850,
0
a. First column,
0
(1) Fifth full paragraph (amendatory instruction 19(a)), last line the
``beneficiary; and'' is corrected to read ``beneficiary;''
0
(2) After the fifth full paragraph and before the sixth full paragraph,
the amendatory instructions are corrected by adding the following:
``b. In the definition of `high priority measure', the phrase `care
coordination, opioid, or health equity-related quality measure.' is
removed and added in its place the phrase `care coordination or opioid-
related quality measure.' ''
0
(3) Sixth full paragraph (amendatory instruction 19(b)), line 1, the
phrase ``b. Revising the definitions of'' is corrected to read ``c.
Revising the definitions of''.
[[Page 39160]]
0
c. Second column, 15th full paragraph (Sec. 414.1380(b)(1)(i)) through
the third column first full paragraph (Sec. 414.1380(b)(1)(i)(C)),
beginning with the phrase ``(i) Measure achievement points. For'' and
ending with the phrase ``achievement points.'' is corrected to read as
follows:
``(i) Measure achievement points. For the CY 2017 through 2022
performance periods/2019 through 2024 MIPS payment years, MIPS eligible
clinicians receive between 3 and 10 measure achievement points
(including partial points) for each measure required under Sec.
414.1335 on which data is submitted in accordance with Sec. 414.1325
that has a benchmark at paragraph (b)(1)(ii) of this section, meets the
case minimum requirement at paragraph (b)(1)(iii) of this section, and
meets the data completeness requirement at Sec. 414.1340 and for each
administrative claims-based measure that has a benchmark at paragraph
(b)(1)(ii) of this section and meets the case minimum requirement at
paragraph (b)(1)(iii) of this section. Except as provided under
paragraph (b)(1)(i)(C) of this section, beginning with the CY 2023
performance period/2025 MIPS payment year, MIPS eligible clinicians
receive between 1 and 10 measure achievement points (including partial
points) for each such measure. Except as specified otherwise under
paragraph (b)(1)(ii) of this section, the number of measure achievement
points received for each such measure is determined based on the
applicable benchmark decile category and the percentile distribution.
MIPS eligible clinicians receive zero measure achievement points for
each measure required under Sec. 414.1335 on which no data is
submitted in accordance with Sec. 414.1325. MIPS eligible clinicians
that submit data in accordance with Sec. 414.1325 on a greater number
of measures than required under Sec. 414.1335 are scored only on the
required measures with the greatest number of measure achievement
points. Beginning with the CY 2019 performance period/2021 MIPS payment
year, MIPS eligible clinicians that submit data in accordance with
Sec. 414.1325 on a single measure via multiple collection types are
scored only on the data submission with the greatest number of measure
achievement points.''.
0
d. Third column (Sec. 414.1380(b)(1),
0
(1) Third full paragraph (Sec. 414.1380(b)(1)(ii)(D)), line 1, the
phrase ``(D) Beginning with the CY 2023'' is corrected to read ``(D)(1)
Beginning with the CY 2023''.
0
(2) Fourth full paragraph (Sec. 414.1380(b)(1)(ii)(E)), line 1, the
phrase ``(E) Beginning with the CY 2025''is corrected to read ``(2)
Beginning with the CY 2025''.
0
(3) Fifth full paragraph, (Sec. 414.1380(b)(1)(ii)(E)(1)), line 1, the
phrase ``(1) CMS awards achievement points ``is corrected to read ``(i)
CMS awards achievement points''.
0
(4) Sixth full paragraph, (Sec. 414.1380(b)(1)(ii)(E)(2)), line 1, the
phrase ``(2) CMS awards achievement points ``is corrected to read
``(ii) CMS awards achievement points''.
0
21. On page 32851, third column, 17th full paragraph (Sec.
414.1400(d)(3)(vi)(A)), the phrase ``employment of a'' is corrected to
read ``employ a''.
C. Correction of Errors in the Appendices
22. On page 33162, Table DD.2 Colorectal Cancer Screening, the
Substantive Change row is corrected to read: ``Reviewed--to meet the
quality action, there must be documentation in the medical record that
the clinician reviewed the colonoscopy report and discussed the
findings with the patient. The colonoscopy report may also be provided
by the patient for the clinician's review/discussion during the visit
and should be documented in the medical record.''.
23. On page 33183, third column, last paragraph, the phrase
``Symbol Key:'' is corrected to read as follows:
``Symbol Key:
Single asterisk (*): existing measures and improvement activities
with proposed revisions.
Double asterisk (**): measures and improvement activities only
available when included in an MVP.
Single exclamation point (!): improvement activities with an
advancing health and wellness component.'' .
24. On page 33208, in table B.2 titled ``Advancing Cancer Care MVP,
Radiation Oncology Clinical Groupings'', last row (Radiation Oncology),
the entry is corrected to read as follows:
Table B.2--Advancing Cancer Care MVP Clinical Groupings
----------------------------------------------------------------------------------------------------------------
Advancing Cancer Care MVP
-----------------------------------------------------------------------------------------------------------------
Quality
Clinical grouping -------------------------------------------------------------- Cost
Measure Outcome High priority
----------------------------------------------------------------------------------------------------------------
Radiation Oncology............. Q102: Prostate Cancer: No............... Yes.............. COST_PC_1:
Avoidance of Overuse Prostate Cancer
of Bone Scan for
Staging Low Risk
Prostate Cancer
Patients (Collection
Type: eCQM, MIPS CQM).
(*) Q143: Oncology: No............... Yes.............. .................
Medical and
Radiation--Pain
Intensity Quantified
(Collection Type:
eCQM, MIPS CQM).
Q144: Oncology: No............... Yes.............. (*) TPCC_1: Total
Medical and Per Capita Cost
Radiation--Plan of
Care for Pain
(Collection Type:
MIPS CQM).
----------------------------------------------------------------------------------------------------------------
25. On page 33219, bottom of page, the Coordinating Stroke Care to
Promote Prevention and Cultivate Positive Outcomes Improvement
Activities is corrected to read as follows:
(*)(!)IA_AHW_X: Chronic Care Preventive Care Management
for Empaneled Patients
IA_BE_1: Use of certified EHR to capture patient reported
outcomes
IA_BE_4: Engagement of Patients through Implementation of
New Patient Portal
IA_BE_6: Regularly Assess Patient Experience of Care and
Follow Up on Findings
IA_BE_24: Financial Navigation Program
IA_BMH_15: Behavioral/Mental Health and Substance Use
Screening and Referral for Older Adults
IA_CC_13: Practice improvements to align with OpenNotes
principles
[[Page 39161]]
IA_CC_17: Patient Navigator Program
IA_MVP: Practice-Wide Quality Improvement in MIPS Value
Pathways
IA_PM_15: Implementation of episodic care management
practice improvements
26. On page 33255, first through third columns, beginning with the
phrase ``Quality Measures'' and ending with the phrase ``component.''
is corrected by removing the language.
Cortney L. McCormick,
Executive Secretary to the Department, Department of Health and Human
Services.
[FR Doc. 2025-15492 Filed 8-13-25; 8:45 am]
BILLING CODE 4120-01-P