Over the past year, we’ve covered many topics related to the final Medicare Physician Fee Schedule rule for 2023. The proposed final rule, which was released this summer, was still a work-in-progress; many industry figures had strong criticisms of some of its aspects, and campaigns were launched to appeal to CMS to change some of its less savory elements.
Now, the final rule has officially been released. While some of the aforementioned criticism was taken into account, other critiques seem to have been ignored entirely. Today, we’re going to break down some of the many changes made to the Medicare Physician Fee Schedule rule and how those alterations may impact the industry.
First, the conversion factor. In our previous post, we discussed the impending statutory 4% Pay-As-You-Go (PAYGO) cut and the budget neutrality reduction to the Medicare conversion factor. Many critics asked CMS to finalize a smaller cut than the initially proposed 4.42% reduction. However, the final cut is actually more severe than the initial proposal, coming in at -4.47%. This number accounts for the expiration of the 3.00% increase in MPFS payments for CY 2022.
Furthermore, this number is not static. If Congress fails to act in 2023, the conversion factor will again be cut by 3% in the following year.
Next, we’ll move on to Shared (or Split) E/M Services. Initially, CMS had proposed using only time spent with the patient to identify the billing practitioner during visits that are split between a physician and a non-physician practitioner. This move was broadly criticized at the time; as such, the proposed change has been delayed for another year. This means that the current structure of determining the billing practitioner laid out in our November 2021 post will still apply going into 2023.
Third, let’s discuss Critical Care services. Current Procedural Terminology (CPT) guidance advised against the proposed changes laid out in earlier versions of the final Medicare Physician Fee Schedule rule. The current final rule acknowledges but ignores CPT’s assessment, saying, “we are retaining the CPT code 99292, as it was finalized in the CY 2022 PFS, and we again note that it can be billed after 104 cumulative total minutes were spent providing critical care. However, we will take commenters’ concerns regarding alignment with CPT instructions and the valuation of CPT code 99291 under consideration.”
With the spread of COVID-19, telehealth offerings were expanded to allow patients to receive certain treatments over the phone or through video calls. As case numbers have decreased, these services have remained in place. While these expanded telehealth offerings have not yet been declared permanent additions to the Medicare telehealth services list, the final rule makes certain services, including emergency services, available via telehealth through the end of 2023. This will allow them to collect more data about whether these additional services should be permanently included in the Medicare telehealth services list.
Moreover, CMS will allow an additional 151 days after the expiration of the Public Health Emergency (PHE) to extend the application of certain Medicare telehealth flexibilities. This includes current waivers for the previous restrictions stating that telehealth could only be performed when the patient was in certain healthcare settings and in certain rural areas. Currently, the PHE is set to expire on January 11th, although it has been extended multiple times since 2020.
Finally, earlier this year we detailed numerous changes made to the documentation requirements for Emergency Department coding. In this iteration of the Rule, CMS finalizes the proposals discussed in our aforementioned post, which will take effect at the beginning of the calendar year.
While some aspects of the final Medicare Physician Fee Schedule rule are positive, others, such as the 4.47% discussed above, cause concern. We will keep you updated about any further changes made to the rule.