Modernizing medical coding to accurately classify and reimburse providers of restorative treatments

(a) In general The Secretary of Health and Human Services (referred to in this section as the Secretary), in collaboration with the Administrator of the Centers for Medicare & Medicaid Services, the Director of the National Center for Health Statistics of the Centers for Disease Control and Prevention, and the CPT Editorial Panel of the American Medical Association, shall take all necessary actions to update, not later than 1 year after the date of enactment of this Act, diagnostic and procedural codes related to infertility treatments to reflect the latest knowledge and practices related to the practice of restorative reproductive medicine. (b) Requirements In carrying out subsection (a), the Secretary shall— (1) conduct a thorough review and revision of ICD–10–CM codes for conditions such as endometriosis, polycystic ovary syndrome, uterine fibroids, adenomyosis, blocked fallopian tubes, and male mechanisms of infertility to ensure accurate classification of severe, chronic reproductive health conditions requiring medical or surgical intervention; (2) develop and implement new ICD–10–PCS codes for laparoscopic excision, hysteroscopic procedures, and other minimally invasive surgeries aimed at addressing such conditions, including the excision of fibroids, ovarian cysts, and adenomyosis-related tissue removal; (3) revise diagnostic and procedural codes under the International Classification of Diseases to more accurately reflect severe and chronic reproductive conditions; (4) develop new Current Procedural Terminology codes for minimally invasive surgeries and other interventions that target infertility-related conditions, specifically including laparoscopic excision, differentiation between laparoscopic ablation and laparoscopic excision of endometriosis, appendectomy related to endometriosis, bowel resection related to endometriosis, hysteroscopic myomectomy, abdominal myomectomy, cystectomy, other minimally invasive procedures that directly treat underlying reproductive health conditions, and for family planning services, specifically including female cycle charting instruction; (5) establish new Healthcare Common Procedure Coding System codes to ensure appropriate reimbursement under the Medicare and Medicaid programs for reproductive health-related surgical procedures, postoperative care, and family planning services, specifically including female cycle charting instruction; (6) conduct an actuarial analysis to determine appropriate reimbursement rates and assign relative value units to reflect the complexity and time required for these procedures, including physician visits, surgical interventions, education, and care coordination, ensuring that providers are incentivized to offer thorough diagnostic and restorative care; and (7) implement a restorative reproductive medicine bundled payment model accurately reimbursing health care providers for the time and resources needed to identify, diagnose, and treat the underlying cause of infertility or reproductive health condition in order to provide restorative fertility care, including— (A) bundles that include diagnostics, medical management, surgical intervention, education, care coordination, and extended physician time; and (B) establishing a corresponding set of Current Procedural Terminology codes for the bundle type variations and conduct an actuarial analysis to determine appropriate reimbursement rates and assign relative value units reflecting the complexity of restorative care.