CMS Releases 2024 Medicare Physician Fee Schedule Proposed Rule

On July 13, 2023, CMS released the 2024 Medicare Physician Fee Schedule (PFS) proposed rule, which addresses Medicare payment and quality provisions for physicians in the coming year. Under the proposal, physicians will see a decrease to the conversion factor of 3.36% on Jan. 1, 2024, going from $33.8872 to $32.7476.

CMS projects that overall reimbursement for spine surgery services will remain flat compared to 2023, with changes to policies and individual services roughly balancing out. This estimate is based on the entire interventional pain management profession and can vary widely depending on the mix of services provided in a practice.

The confluence of conversion factor cuts for budget neutrality, 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, threatening patient access to Medicare-participating physicians and services.

ISASS, along with other medical societies, has aligned with the American Medical Association (AMA) on a set of principles to guide advocacy efforts on Medicare physician payment reform and strongly supports H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which would provide a permanent, annual update equal to the increase in the Medicare Economic Index, allowing physicians to invest in their practices and implement new strategies to provide high-value care.

One new spine surgery code Cervical Total Disc Replacement, Each Additional Level (CPT code 22868) was proposed for value at a relative value unit (RVU) lower than what ISASS and other societies recommended through the AMA RUC. The RUC recommended a work RVU of 7.50, and CMS proposed 6.88. ISASS will work with other stakeholders to increase the RVU to 7.50 in alignment with the RUC recommended RVU in comments to CMS. The primary level code for Cervical Total Disc Replacement (CPT code 22867) was also reviewed by CMS and was maintained at its current work RVU of 27.13, which ISASS agrees with for appropriate payment.

Comments are due on September 11, 2023.

To read the full rule see here: 2024 Medicare Physician Fee Schedule (PFS) proposed rule