stack/src/llm/vocab/themes.yaml

# Closed theme vocabulary for tagging PFS rulemaking comments (P35, #574).
#
# Seeded from the section headings of the CY2018–CY2027 PFS proposed and
# final rules (dev/scripts/llm_vocab_candidates.py over fr_anchors) and the
# hand code families; curated by hand. Slugs are stable once published —
# retire a theme by moving it to `retired:` rather than deleting it, and
# bump `version` whenever a slug, definition or synonym list changes, since
# every tag run records the version it used.
version: 2
themes:
  - slug: conversion-factor
    label: Conversion factor and payment update
    definition: The annual PFS conversion factor, statutory update percentage, budget-neutrality adjustment, or the overall payment cut or increase.
    synonyms: [conversion factor, CF, payment update, budget neutrality, statutory update, payment cut, physician payment cut]
    sections: [Conversion Factor, Physician Fee Schedule Update, Budget Neutrality]
  - slug: practice-expense
    label: Practice expense RVUs
    definition: Practice expense methodology, direct and indirect PE inputs, clinical labor pricing, supply and equipment pricing, or the PE/HR survey data.
    synonyms: [practice expense, PE RVU, clinical labor, supply pricing, equipment pricing, indirect practice expense, PE/HR, AMA PPIS survey]
    sections: [Determination of Practice Expense (PE) Relative Value Units (RVUs), Practice Expense Methodology]
  - slug: work-rvu
    label: Work RVUs and code valuation
    definition: Physician work RVUs, RUC recommendations, time assumptions, or the valuation of specific CPT/HCPCS codes.
    synonyms: [work RVU, RUC recommendation, valuation of specific codes, intraservice time, survey data, code valuation]
    sections: [Valuation of Specific Codes, Work RVUs]
  - slug: malpractice-rvu
    label: Malpractice RVUs
    definition: Malpractice (MP) RVU methodology, premium data, or specialty risk factors.
    synonyms: [malpractice RVU, MP RVU, professional liability insurance premium, risk factor]
    sections: [Determination of Malpractice Relative Value Units (RVUs)]
  - slug: misvalued-codes
    label: Potentially misvalued codes
    definition: Identification, review or revaluation of potentially misvalued services, including the statutory misvalued-code target.
    synonyms: [misvalued, potentially misvalued codes, misvalued code target, revaluation]
    sections: [Potentially Misvalued Services Under the PFS]
  - slug: gpci-localities
    label: GPCIs and payment localities
    definition: Geographic practice cost indices, locality definitions, or geographic adjustment of payment.
    synonyms: [GPCI, geographic practice cost index, payment locality, locality, geographic adjustment, work GPCI floor]
    sections: [Geographic Practice Cost Indices (GPCIs), Payment Localities]
  - slug: telehealth
    label: Medicare telehealth services
    definition: The Medicare telehealth services list, originating-site and geographic restrictions, audio-only, virtual direct supervision, or telehealth flexibilities after the public health emergency.
    synonyms: [telehealth, telemedicine, audio-only, originating site, distant site, virtual supervision, telehealth list, home as originating site]
    sections: [Medicare Telehealth Services, Payment for Medicare Telehealth Services Under Section 1834(m) of the Act]
  - slug: communication-technology-services
    label: Communication technology-based services
    definition: Virtual check-ins, e-visits, remote evaluation of images, interprofessional consultations and other communication technology-based services that are not telehealth.
    synonyms: [virtual check-in, e-visit, online digital E/M, interprofessional consultation, remote evaluation, CTBS, G2012, 99421]
    sections: [Communication Technology-Based Services (CTBS)]
  - slug: remote-monitoring
    label: Remote physiologic and therapeutic monitoring
    definition: Remote physiologic monitoring (RPM) or remote therapeutic monitoring (RTM) codes, device supply days, or monitoring time requirements.
    synonyms: [remote physiologic monitoring, RPM, remote therapeutic monitoring, RTM, 99454, 99457, 98977, 16 days]
    sections: [Remote Physiologic Monitoring]
  - slug: evaluation-management
    label: Evaluation and management visits
    definition: Office/outpatient, hospital, nursing facility or home E/M visit coding, documentation guidelines, level selection, prolonged services, or split/shared visits.
    synonyms: [E/M, evaluation and management, office visit, 99213, 99214, prolonged services, split/shared, level selection, documentation guidelines]
    sections: [Evaluation & Management (E/M) Visits, Evaluation & Management (E/M) Guidelines and Care Management Services]
  - slug: visit-complexity-add-on
    label: Visit complexity add-on (G2211)
    definition: The office/outpatient visit complexity add-on code G2211, its use with modifier 25, or its budget impact.
    synonyms: [G2211, visit complexity, complexity add-on, longitudinal relationship, modifier 25]
    sections: [Visit Complexity]
  - slug: care-management
    label: Care management services
    definition: Chronic care management, principal care management, transitional care management, advanced primary care management, or other monthly care-management codes and their consent, staffing and time requirements.
    synonyms: [chronic care management, CCM, principal care management, PCM, transitional care management, TCM, advanced primary care management, APCM, 99490, 99439, G0556, care management]
    sections: [Care Management Services, Advanced Primary Care Management]
  - slug: behavioral-health
    label: Behavioral health integration and services
    definition: Behavioral health integration, collaborative care, psychotherapy, marriage and family therapists and mental health counselors, or crisis and safety-planning services.
    synonyms: [behavioral health, mental health, collaborative care, BHI, psychotherapy, MFT, MHC, safety planning, crisis psychotherapy, community health integration]
    sections: [Behavioral Health Services]
  - slug: opioid-treatment
    label: Opioid treatment programs and substance use disorder
    definition: Opioid treatment program bundled payments, medications for opioid use disorder, or substance use disorder treatment via telehealth.
    synonyms: [opioid treatment program, OTP, medication for opioid use disorder, MOUD, buprenorphine, methadone, substance use disorder, SUD]
    sections: [Requirements for Opioid Treatment Programs (OTP)]
  - slug: caregiver-training
    label: Caregiver training services
    definition: Caregiver training services furnished to a patient's caregivers, with or without the patient present.
    synonyms: [caregiver training, CTS, 97550, 96202]
    sections: [Caregiver Training Services]
  - slug: community-health-social-needs
    label: Community health integration and social needs
    definition: Community health integration, principal illness navigation, social determinants of health risk assessment, or community health worker services.
    synonyms: [community health integration, CHI, principal illness navigation, PIN, social determinants of health, SDOH risk assessment, community health worker, G0019, G0136]
    sections: [Community Health Integration, Principal Illness Navigation]
  - slug: palliative-care
    label: Palliative and serious-illness care
    definition: Community-based palliative care, advance care planning, hospice interaction, or serious-illness care management.
    synonyms: [palliative care, advance care planning, ACP, serious illness, hospice, end-of-life]
    sections: [Request for Information on Community-Based Palliative Care]
  - slug: supervision
    label: Supervision requirements
    definition: Direct, general or virtual supervision of auxiliary personnel, incident-to services, or supervision of diagnostic tests and residents.
    synonyms: [direct supervision, general supervision, incident to, incident-to, supervision of residents, virtual presence, teaching physician]
    sections: [Direct Supervision by Interactive Telecommunications Technology, Teaching Physician Documentation Requirements]
  - slug: non-physician-practitioners
    label: Non-physician practitioners and scope
    definition: Nurse practitioners, physician assistants, clinical nurse specialists, therapists or other non-physician practitioners' billing, supervision or scope-of-practice policies.
    synonyms: [nurse practitioner, physician assistant, PA, NP, advanced practice, scope of practice, CRNA, non-physician practitioner, NPP]
    sections: [Physician Assistants, Nurse Practitioners]
  - slug: therapy-services
    label: Physical, occupational and speech therapy
    definition: Therapy services, therapy assistants and the CQ/CO modifiers, the KX modifier threshold, plan-of-care certification, or therapy supervision.
    synonyms: [physical therapy, occupational therapy, speech-language pathology, therapy assistant, CQ modifier, CO modifier, KX modifier, therapy threshold, plan of care]
    sections: [Therapy Services, Therapy Caps]
  - slug: drugs-biologicals
    label: Part B drugs and biologicals
    definition: Average sales price methodology, drug add-on percentages, biosimilars, discarded-drug refunds, or drug payment under Part B.
    synonyms: [average sales price, ASP, WAC, biosimilar, discarded drug, JW modifier, JZ modifier, Part B drug, drug payment, 340B]
    sections: [Part B Drug Payment, Payment for Biosimilar Biological Products]
  - slug: vaccines-preventive
    label: Vaccines and preventive services
    definition: Vaccine administration payment, preventive services coverage, screening services, or the Medicare Diabetes Prevention Program.
    synonyms: [vaccine administration, preventive services, screening, colorectal cancer screening, Medicare Diabetes Prevention Program, MDPP, hepatitis B vaccine, HIV PrEP]
    sections: [Medicare Diabetes Prevention Program, Preventive Services]
  - slug: skin-substitutes
    label: Skin substitutes and wound care
    definition: Payment or coding for skin substitute products, cellular and tissue-based products, or wound care services.
    synonyms: [skin substitute, cellular and tissue-based product, CTP, wound care, Q4 code, amniotic, dermal substitute]
    sections: [Skin Substitutes]
  - slug: dental-services
    label: Dental services
    definition: Medicare payment for dental services inextricably linked to covered medical services.
    synonyms: [dental, oral health, dental services, inextricably linked]
    sections: [Dental Services]
  - slug: global-surgery
    label: Global surgical packages
    definition: Global surgery periods, post-operative visit reporting, or the transfer-of-care modifier for global packages.
    synonyms: [global surgery, global period, 010-day, 090-day, post-operative visit, modifier 54, modifier 55, transfer of care, G0559]
    sections: [Global Surgery]
  - slug: anesthesia
    label: Anesthesia services
    definition: The anesthesia conversion factor, anesthesia base units, or anesthesia billing and supervision.
    synonyms: [anesthesia, anesthesia conversion factor, base units, CRNA, medical direction]
    sections: [Anesthesia Services, Anesthesia Conversion Factor]
  - slug: imaging-radiology
    label: Imaging and radiology
    definition: Diagnostic imaging payment, appropriate use criteria for advanced imaging, or radiology assistants and supervision.
    synonyms: [imaging, radiology, appropriate use criteria, AUC, clinical decision support, CT, MRI, radiologist assistant]
    sections: [Appropriate Use Criteria for Advanced Diagnostic Imaging Services]
  - slug: laboratory
    label: Clinical laboratory fee schedule
    definition: The clinical laboratory fee schedule, private payer rate reporting, specimen collection, or laboratory test payment.
    synonyms: [clinical laboratory fee schedule, CLFS, private payor rate, PAMA, laboratory test, specimen collection]
    sections: [Clinical Laboratory Fee Schedule]
  - slug: ambulance
    label: Ambulance services
    definition: The ambulance fee schedule, ground or air ambulance payment, or ambulance cost data collection.
    synonyms: [ambulance, ambulance fee schedule, ground ambulance, air ambulance, ambulance cost collection]
    sections: [Ambulance Fee Schedule]
  - slug: dme-supplies
    label: Durable medical equipment and supplies
    definition: DME infusion drugs, DMEPOS competitive bidding, or supplies furnished with physician services.
    synonyms: [durable medical equipment, DME, DMEPOS, infusion drugs, competitive bidding]
    sections: [Payment for DME Infusion Drugs]
  - slug: esrd-dialysis
    label: ESRD and dialysis services
    definition: Monthly capitation payment for ESRD-related services, home dialysis, or kidney disease education.
    synonyms: [ESRD, dialysis, monthly capitation payment, MCP, home dialysis, kidney disease education]
    sections: [Monthly Capitation Payment (MCP) for ESRD-Related Services]
  - slug: rhc-fqhc
    label: Rural health clinics and FQHCs
    definition: Payment or care-coordination policies for rural health clinics and federally qualified health centers.
    synonyms: [rural health clinic, RHC, federally qualified health center, FQHC, G0511, all-inclusive rate]
    sections: [Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)]
  - slug: rural-access
    label: Rural and underserved access
    definition: Access to care in rural or underserved areas, workforce shortages, or health equity concerns raised about a policy's effect on access.
    synonyms: [rural, underserved, health equity, access to care, workforce shortage, health professional shortage area, HPSA]
    sections: [Health Equity]
  - slug: shared-savings-program
    label: Medicare Shared Savings Program
    definition: Shared Savings Program ACO participation, benchmarking, risk tracks, quality reporting, beneficiary assignment, or advance investment payments.
    synonyms: [Shared Savings Program, MSSP, accountable care organization, ACO, benchmark, ENHANCED track, BASIC track, beneficiary assignment, advance investment payment]
    sections: [Medicare Shared Savings Program]
  - slug: quality-payment-program
    label: Quality Payment Program and MIPS
    definition: MIPS categories, MIPS Value Pathways, scoring, performance thresholds, or the QPP reporting requirements.
    synonyms: [Quality Payment Program, QPP, MIPS, MIPS Value Pathway, MVP, performance threshold, promoting interoperability, cost category, improvement activities]
    sections: [Updates to the Quality Payment Program]
  - slug: advanced-apm
    label: Advanced APMs and APM incentives
    definition: Advanced alternative payment model participation, qualifying participant thresholds, the APM incentive payment, or the APM conversion factor.
    synonyms: [advanced APM, alternative payment model, qualifying participant, QP threshold, APM incentive, APM conversion factor]
    sections: [Advanced Alternative Payment Models]
  - slug: quality-measures
    label: Quality measures and reporting
    definition: Specific quality measures, measure specifications, electronic clinical quality measures, or measure reporting burden.
    synonyms: [quality measure, eCQM, measure specification, reporting burden, measure set, benchmarking of measures]
    sections: [Quality Measures]
  - slug: innovation-models
    label: Innovation Center models
    definition: CMS Innovation Center models and demonstrations, including primary care, kidney, oncology or radiation models.
    synonyms: [Innovation Center, CMMI, model, demonstration, Primary Care First, ACO REACH, oncology care model, radiation oncology model]
    sections: [Innovation Center Models]
  - slug: self-referral
    label: Physician self-referral law
    definition: Stark law exceptions, the annual code list update, or self-referral compliance.
    synonyms: [self-referral, Stark, physician self-referral law, designated health services]
    sections: [Physician Self-Referral Law]
  - slug: enrollment-program-integrity
    label: Enrollment and program integrity
    definition: Provider enrollment requirements, revocations, prior authorization, fraud, waste and abuse controls, or medical review.
    synonyms: [enrollment, revocation, program integrity, fraud waste and abuse, prior authorization, medical review, overpayment, audit]
    sections: [Medicare Provider Enrollment, Program Integrity]
  - slug: coverage-policy
    label: Coverage and benefit categories
    definition: Whether a service is a covered Medicare benefit, benefit-category determinations, or national coverage policy raised in the rule.
    synonyms: [coverage, benefit category, covered service, national coverage determination, NCD, reasonable and necessary]
    sections: [Coverage]
  - slug: beneficiary-cost-sharing
    label: Beneficiary cost sharing
    definition: Coinsurance, deductibles, or beneficiary out-of-pocket effects of a payment policy.
    synonyms: [cost sharing, coinsurance, deductible, out-of-pocket, beneficiary liability, copay]
    sections: [Telehealth Modalities and Cost-sharing]
  - slug: administrative-burden
    label: Administrative burden and documentation
    definition: Documentation, paperwork, reporting or compliance burden imposed on practices, including collection-of-information estimates.
    synonyms: [administrative burden, documentation burden, paperwork, compliance burden, collection of information, patients over paperwork, prior authorization burden]
    sections: [Collection of Information Requirements]
  - slug: regulatory-impact
    label: Regulatory impact and specialty impacts
    definition: The regulatory impact analysis, specialty-level payment impact tables, or estimated effects on practices and beneficiaries.
    synonyms: [regulatory impact analysis, impact table, specialty impact, Table 118, estimated impact, small entities]
    sections: [Regulatory Impact Analysis]
  - slug: medicare-economic-index
    label: Medicare Economic Index and cost weights
    definition: The Medicare Economic Index, its rebasing or revised cost-share weights, and their effect on RVU allocation.
    synonyms: [Medicare Economic Index, MEI, cost share weights, rebasing]
    sections: [The Percentage Change in the Medicare Economic Index (MEI)]
  - slug: efficiency-adjustment
    label: Efficiency adjustment to work RVUs
    definition: An across-the-board efficiency adjustment to work RVUs or intraservice time for non-time-based services.
    synonyms: [efficiency adjustment, efficiency gains, across-the-board reduction, non-time-based services]
    sections: [Efficiency Adjustment]
  - slug: site-of-service
    label: Site of service and facility payment
    definition: Facility versus non-facility payment, site-neutral policies, hospital outpatient department comparisons, or indirect PE by setting.
    synonyms: [site of service, site neutral, facility rate, non-facility rate, hospital outpatient department, HOPD, office-based]
    sections: [Site of Service]
  - slug: hospice-home-health
    label: Hospice and home health interaction
    definition: Hospice face-to-face encounters, homebound status, home health certification, or physician services interacting with hospice and home health benefits.
    synonyms: [hospice, home health, face-to-face encounter, homebound, certification of home health]
    sections: [Clarification of Homebound Status Under the Medicare Home Health Benefit, Telehealth and the Medicare Hospice Face-to-Face Encounter Requirement]
  - slug: interoperability-health-it
    label: Health IT and interoperability
    definition: Certified EHR technology, promoting interoperability requirements, data exchange, or the EHR incentive programs.
    synonyms: [electronic health record, EHR, certified EHR technology, CEHRT, interoperability, health information exchange, promoting interoperability]
    sections: [Medicare EHR Incentive Program, Medicaid Promoting Interoperability Program Requirements]
  - slug: price-transparency
    label: Price transparency
    definition: Public disclosure of prices, charges or payment rates to beneficiaries.
    synonyms: [price transparency, charge transparency, disclosure of prices]
    sections: [Request for Information on Price Transparency]
  - slug: covid-phe
    label: COVID-19 public health emergency flexibilities
    definition: Policies tied to the COVID-19 public health emergency and their extension or expiration.
    synonyms: [public health emergency, PHE, COVID-19, pandemic, flexibilities, waiver]
    sections: [Counting of Resident Time During the PHE for the COVID-19 Pandemic]
  - slug: data-requests-rfi
    label: Requests for information
    definition: Responses to a request for information or comment solicitation rather than a specific proposal.
    synonyms: [request for information, RFI, comment solicitation, seeking comment, solicit feedback]
    sections: [Requests for Information]
  - slug: coding-descriptors
    label: Coding and code descriptors
    definition: Creation, deletion or crosswalk of CPT/HCPCS codes, code descriptors, or bundling of services into other codes.
    synonyms: [new code, deleted code, HCPCS code, G code, crosswalk, bundled, code descriptor, CPT Editorial Panel, unbundle]
    sections: [Proposed Valuation of Specific Codes]
  - slug: modifier-25-same-day
    label: Same-day procedures with an E/M visit (modifier 25)
    definition: Payment reduction or policy for a procedure furnished on the same day as an E/M visit billed with modifier 25, or multiple-procedure payment reductions.
    synonyms: [modifier 25, modifier -25, same-day procedure, same day visit, 50 percent reduction, multiple procedure payment reduction, come back for a second visit]
    sections: [Payment for Procedures Furnished With an E/M Visit]
  - slug: lactation-services
    label: Lactation care services
    definition: New lactation care service codes, who may furnish them, and their payment or supervision conditions.
    synonyms: [lactation, lactation consultant, IBCLC, breastfeeding, 978XX, lactation care services]
    sections: [Lactation Care Services]
  - slug: health-coaching
    label: Health and wellness coaching
    definition: Health and wellness coaching services (CPT 0591T–0593T), their national payment and conditions of payment.
    synonyms: [health coaching, wellness coaching, health and well-being coaching, 0591T, 0592T, 0593T, nurse coach]
    sections: [Health Coaching]
  - slug: radiation-therapy
    label: Radiation therapy and proton treatment
    definition: Payment or coverage for radiation oncology, proton beam therapy, or radiation treatment delivery codes.
    synonyms: [radiation therapy, radiation oncology, proton therapy, proton beam, treatment delivery, IMRT]
    sections: [Radiation Therapy Services]
retired: []