The Centers for Medicare & Medicaid Services (CMS) has issued its calendar year (CY) 2023 final rule for the physician fee schedule (PFS).
Key provisions of the rule include:
- Conversion Factor: The final CY 2023 PFS conversion factor is $33.06. This represents a decrease of $1.55 from the CY 2022 PFS conversion factor of $34.61. It reflects the expiration of a 3% statutory payment increase, a zero percent conversion factor update, and a budget-neutrality adjustment.
- Evaluation and Management (E/M) Visits: CMS finalized several changes in documentation and coding requirements for E/M visits, including hospital inpatient, hospital observation, emergency department, nursing facility, home or residence services, and cognitive impairment assessment services. Additionally, CMS finalized a delay of the implementation of its policy to define the substantive portion of a split (or shared) visit based on the amount of time spent by the billing practitioner for one year, until Jan. 1, 2024.
- Medicare Shared Savings Program: CMS finalized significant changes to the Medicare Shared Savings Program. Among the changes, CMS modified the calculation methodology for accountable care organizations’ (ACOs) benchmarks to reduce costs and encourage long-term participation in the program. CMS also finalized policies to incentivize new ACOs in rural and underserved areas, including providing advance investment payments. The rule also updated quality measurement policies and incorporated a new health equity adjustment that awards bonus points to ACOs serving higher proportions of underserved or dually eligible beneficiaries. A fact sheet specific to these policies is available on CMS’ website.
- Telehealth: CMS finalized several changes to Medicare telehealth policies to account for statutory changes related to the termination of flexibilities after the end of the COVID-19 public health emergency (PHE). The changes include extending the length of time certain services will remain on Medicare telehealth temporarily to 151 days after the end of the PHE, maintaining originating site- and geographic-restriction flexibilities until 151 days after the end of the PHE, and delaying the in-person visit requirements for mental health services furnished via telehealth until 152 days after the end of the PHE.
- Clinical Laboratory Fee Schedule: As required by the Protecting Medicare and American Farmers from Sequester Cuts Act, CMS delayed the laboratory payment data reporting period to Jan. 1-March 31, 2023, based on the data collection period of Jan. 1-June 30, 2019. CMS also delayed phased-in payment cuts to lab rates and made certain modifications and clarifications to the Medicare clinical laboratory fee schedule requirements for the travel allowance for specimen collection.
- Behavioral Health Policies: CMS finalized several policies intended to improve access to, and quality of, mental health care services. Specifically, CMS made an exception to the direct supervision requirements to allow behavioral health services provided under the general supervision of a physician or non-physician practitioner, rather than under direct supervision, when these services or supplies are provided by auxiliary personnel incident to the services of a physician (or non-physician practitioner). A blog on CMS’ behavioral health policies in the final rule is available on CMS’ website.
- Quality Payment Program: CMS finalized five new, optional Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) and revised the seven previously finalized MVPs to account for the addition of new measures and activities, the removal of measures and activities, and the expansion of a MVP topic that would allow additional specialties to report the MVP. These value pathways align the reporting requirements of the four MIPS performance categories around specific clinical specialties, medical conditions, or episodes of care. CMS also refined the MIPS subgroup reporting process, increased the quality data completeness threshold, and changed requirements and scoring of the Promoting Interoperability category.
The final rule contains numerous additional policies. A CMS fact sheet is available, and CHA will distribute a detailed summary of the rule to members in the coming weeks.