CMS Issues Final Rule on Medicare Physician Fee Schedule

On November 2, CMS released its calendar year (CY) 2024 final rule for the physician fee schedule. The rule will cut the conversion factor by 3.4%, from $33.89 in CY 2023 to $32.74 in CY 2024. This cut reflects the expiration of the 2.5% statutory payment increase for CY 2023; a 1.25% statutory payment increase for 2024; a 0.00% conversion factor update under the Medicare Access and Children’s Health Insurance Program Reauthorization Act; and a budget-neutrality adjustment.

CMS also finalized a revised definition of the substantive portion of a split (or shared) visit. Specifically, for purposes of Medicare billing in CY 2024, the definition of “substantive portion” means more than half of the total time spent by the physician and non-physician practitioner performing the split (or shared) visit or a substantive part of the medical decision-making.

For the Quality Payment Program (QPP), CMS finalized the creation of five new, optional Merit-based Incentive Payment System (MIPS) Value Pathways for reporting beginning in 2024. CMS also finalized its proposal to increase the performance threshold score that MIPS participants must achieve to earn positive payment adjustments, but it will not increase the quality data completeness threshold as originally proposed. Finally, for the Advanced Alternative Payment Model (APM) track of the QPP, CMS will offer Advanced APM Incentive Payments in CY 2025 to qualifying clinicians. This one-year extension of the Advanced APM bonus payments at a reduced rate of 3.5% was required by the Consolidated Appropriations Act.

The agency also finalized its proposal to withdraw all regulations related to the Appropriate Use Criteria program, citing patient access and financial liability risks. ISASS strongly supports CMS’s decision to pause the program for reevaluation.

Some of the other major provisions include the following:

Telehealth Provisions and Inflation Reduction Act Implementation

To read the full rule, see here.

Contact Us