CMS to the Society “We Are Unable to Approve PALTC Specialty Code Designation”

May 13, 2022
Policy Snapshot

In August of 2017, the Society submitted a request to the Centers for Medicare & Medicaid Services (CMS) for consideration of a new specialty code for post-acute and long-term care (PALTC) medicine. The Society noted that PALTC physicians have the capacity and authority to bill Medicare independently on behalf of their patients and are unique in that the majority of their patients are Medicare beneficiaries. The Society noted that the current physician specialty codes do not capture the field of PALTC medicine. “The codes many currently bill with (Internal, Osteopathic, or Geriatric Medicine) do not fully encompass the long-term care and post-acute care field because they are either too complex or have other extraneous components lacking in the other fields such as visits at multiple skilled nursing facilities.”

Recently, CMS sent a response to the 2017 letter and noted that they are unable to approve a specialty code designation at this time because of “programmatic need and benefit to our beneficiaries, national recognition by specialty designation bodies, and current utilization and programmatic data that is relevant to the request.” CMS requested more information to help better understand the request.

The Society will work with members to thoughtfully respond to CMS’ request and continue our advocacy on approval of a PALTC specialty code designation.