Earlier this month, CMS released its Final Physician Fee Schedule Rule for the calendar year. Naturally, there’s a lot to go over within this rule — and now that we’ve had a bit of time to examine the rule and see the industry’s responses to it, we’ve decided to put together this piece laying out everything you need to know about the Final Physician Fee Schedule Rule for 2024.

To start, let’s discuss Medicare reimbursement. For most specialties, this rule dictates that there will be a 3.39% decrease in Medicare reimbursement, with this lowering attributed to the decreased conversion factor.

However, this gets a little complicated, as this rule also approved a complexity add-on code. This code, dubbed the ‘G2211 code,’ was initially criticized as being too vague and undefined; in the new rule, this lack of definition is not resolved, and experts worry that such vagueness will result in increased utilization by physicians. On the physician side, this may prove beneficial, as employing the G2211 code could provide them with a favorable reimbursement trend for the coming year. This could also assist in resolving issues physicians have with the current rates of pay, which many have argued is too low.

Next, let’s discuss the definition of split/shared visits. CMS finalized the current definition of split/shared visits, allowing consideration of performing the Medical Decision Making (MDM) independently rather than transitioning to determining the billing provider based on time spent caring for the patient. This came as a response to public comments asking that CMS “allow either time or medical decision making to serve as the substantive portion of a split (or shared) visit,” per their website.

Following that, we’ll pivot to discussing one of the areas that has seen the most growth and change since the pandemic: telehealth. Although telehealth was a necessity during the peak of the pandemic, physicians have since realized its place as a tool in everyday care. As a consequence of this, experts have advised that agencies improve their policies regarding telehealth and put significant effort into codifying telehealth as a permanent fixture in modern medicine.

In the new final rule, greater allowances are made for telehealth, though it seems that CMS still isn’t quite ready to commit. According to the Final Physician Fee Schedule Rule, urgent care and other outpatient visits are now permanently allowed via telehealth. Lower acuity ED visits (levels 1-3) and some observation codes are allowed via telehealth as well — though this is only going to be in effect until the end of 2024, at which point it’s uncertain if it will be renewed.

Speaking of uncertainty in telehealth, telehealth services are covered even if the patient is at home in the new Final Rule — however, much like the previous point, this is only the case until the end of 2024. After that telehealth services might only be covered if a patient is physically present in a healthcare setting while receiving the services, or CMS may decide to extend the ability of patients to use telehealth services at home.

Fourth, let’s briefly look at the implementation of Appropriate Use Criteria for Advanced Diagnostic Imaging Programs. The previously discussed rules regarding this are canceled as of this Final Rule, though CMS notes that they “will continue efforts to identify a workable implementation approach, and any such approach would be proposed through subsequent rulemaking.”

Finally, we’ll mention minimum performance for physicians participating in the MIPS program. As opposed to what CMS initially proposed for 2024, the minimum performance to avoid penalty is staying at 75 out of 100 points, rather than increasing to 82 out of 100. This change was applauded by industry professionals, who had previously argued that such a change “would have resulted in a majority of eligible clinicians receiving a negative payment adjustment,” per the Medical Group Management Association (MGMA).

This Final Rule contains many valuable changes for the industry. Still, there is much work to be done — and as these changes are implemented and new rules are rolled out, we will follow along and keep you up-to-date with the evolving situation.