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:

• CMS projects that overall reimbursement for orthopaedic or neurosurgeons will remain flat compared to 2023, with changes to policies and individual services roughly balancing out.
• CMS finalized their proposal to implement a separate add-on code and payment for enhanced visit complexity of primary care and longitudinal care of complex patients. The Health Care Procedural Code Set (HCPCS) Code G2211 would generally be applicable to outpatient office visits as an additional payment, recognizing the costs clinicians may incur when longitudinally treating a patient’s single serious or complex chronic condition. If finalized, establishing payment for this add-on code would have redistributive impacts for all other CY 2024 payments. While those effects are less than estimated for this policy when first proposed for 2021, it still drives a significant portion of the proposed conversion factor reduction.

Telehealth Provisions and Inflation Reduction Act Implementation

• Policies in place until December 31, 2024, include the temporary expansion of telehealth originating sites for services furnished via telehealth to include any site in the U.S. where the beneficiary is located at the time of the telehealth service, including an individual’s home; delaying the requirement for an in-person visit with the physician or practitioner within six months prior to initiating mental health telehealth services; and the continued coverage and payment of telehealth services included on the Medicare Telehealth Services List.
• CMS finalized their proposal to continue defining direct supervision to permit the presence and immediate availability of the supervising practitioner through real-time audio and video interactive telecommunications through December 31, 2024, to avoid an abrupt transition at the end of 2023.
• CMS also finalized a proposal to allow teaching physicians to use audio/video real-time communications technology when the resident furnishes Medicare telehealth services in all residency training locations through December 31, 2024.
• Telephone E/M codes 99441-99443 and 98966-98968 will remain actively priced through 2024 under flexibilities included in the Consolidated Appropriations Act of 2023.
• A proposal to extend current opioid treatment programs’ flexibilities for periodic assessments that are furnished via audio-only telecommunications through the end of CY 2024 was finalized as well.

To read the full rule, see here.