2023 Medicare Physician Fee Schedule Proposed Rule Released

On July 7, 2023, the CMS released the proposed 2023 Medicare Physician Fee Schedule rule. Under the proposal, on January 1, 2023, physicians will see a decrease to the conversion factor from $34.6062 to $33.0775.

As noted by the American Medical Association, “This rule represents the continuation of a troubling trend. The confluence of conversion factor cuts, statutory cuts on the horizon from sequestration and PAYGO rules, and a 0% payment update that fails to account for significant inflation in practice costs creates long-term financial instability in the Medicare physician payment system.” Although ISASS worked with other medical societies to successfully forestall these cuts last year, it is clear that we need to redouble those efforts “to ensure patient access to Medicare-participating physicians and services is not threatened.” In response to the proposed 2023 rule, ISASS and many other organizations have aligned with the American Medical Association on a set of principles to guide advocacy efforts on Medicare physician payment reform.

The following are some highlights from the proposed rule:

Physician Fee Schedule

• Updates to work and/or practice expense (PE) values for evaluation and management (E/M) services codes, including changes to several E/M code families (eg, hospital, emergency medicine, nursing facility and home visits).
• Work and PE values for new/revised codes describing decompression for posterior fusion (CPT codes 63052 and 63053) and posterior fusion with minimal decompression (22630, 22632, 22633, 22634).
• Increased work and PE values for existing laminotomy (CPT codes 63020, 63030, and 63035).
• Delay until 2024 the split (or shared) visits policy finalized in calendar year 2022 for 1 year with a few exceptions. This change would redefine the definition of “substantive portion” as more than half of the total time. Clinicians who furnish split (or shared) visits will continue to have a choice of history, physical examination, or medical decision-making, or more than half of the total practitioner time spent to define the substantive portion, instead of using total time to determine the substantive portion.
• CMS seeks public comment on strategies for improving the Global Surgical Package valuation, as CMS still believes that there is strong evidence suggesting that the RVUs for global packages are inaccurate.Medicare Telehealth and Other Communication Technology Services
  • Policy changes to maintain certain elements of the various telehealth flexibilities authorized on a temporary basis during the COVID-19 public health emergency (PHE). After 151 days following the end of the PHE, many of the services that had been temporarily allowed, including audio-only services, would end.
  • Maintenance of several temporary PHE telehealth codes as Category 3 telehealth codes through at least 2023 to gather more data for future consideration of eventual permanent status as a Medicare telehealth-allowed services.
  • Following the 151-day period after the PHE concludes, telehealth claims would require the appropriate place of service indicator rather than the 95 modifier.

  The current list of telehealth services and their status is available here.

  ISASS is developing comments for submission within the 60-day comment period.

  The Full Text is available here: Proposed 2023 Medicare Physician Fee Schedule rule

  The CMS Press Release is available here: CMS Press Release

  The Fact Sheet is available here: MPFS Fact Sheet