Initial Summary of the Just-Released Medicare Proposed Physician Fee Schedule for 2023

COA will be doing a more in-depth analysis of the proposed rule but here is an initial summary:

  • E&M Visits
    • CMS proposed to adopt a revised coding and documentation framework for Other E&M visit code descriptions including new descriptor times, revised interpretative guidelines, choice of medical decision making or time to select code level, and elimination of history and exam to determine code level.
    • CMS proposed to maintain current policies and create Medicare-specific coding for payment of Other E&M prolonged services.
  • Split/Shared E&M Visits
    • CMS proposed to delay the split/shared visits policy finalized in CY 2022.
    • Clinicians who furnish split/shared visits will continue to have a choice of history, physical exam, 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 until CY 2024.
  • Telehealth
    • CMS proposed to make several services temporarily available during the PHE through CY 2023 on a category III basis to determine whether they could be made permanent.
    • CMS also proposed to extend the duration of time that services are included on a temporary basis during the PHE, but are not included a Category I, II, or III basis for 151 days after the PHE ends.
    • CMS proposed to extend the waiver of the geographic site and originating site restrictions for 151 days after the PHE ends.
    • CMS will also allow some services to be delivered via audio-only communications systems for 151 days after the PHE ends.
    • CMS proposed to require telehealth claims to use the appropriate POS indicator after a period of 151 days after the PHE ends and the 93 modifier will be available to identify audio-only telehealth services.
  • Colorectal Cancer Screening
    • CMS proposed to reduce the minimum age for colorectal cancer screening tests from 50 to 45 for certain Medicare-covered tests which include a minimum age of 50 as a limitation of payment or coverage.
    • Screening colonoscopies would continue to not have a minimum age limitation.
    • CMS also proposed to include follow-on screening colonoscopies after non-invasive stool-based tests return a positive result.
  • Drug Wastage
    • CMS seeks comment on proposals to implement the drug wastage provisions found in section 90004 of the Infrastructure Act, including:
      • How discarded amounts of drugs are determined;
      • Which drugs are subject to refunds;
      • When and how often CMS will notify manufacturers of refunds;
      • When and how often refund payments to CMS are required;
      • The refund calculation methodology; and
      • Dispute resolution and enforcement.
  • Request for Information: Medicare Potentially Underutilized Services
    • In this proposed rule, CMS is seeking feedback from stakeholders to determine ways to identify and improve access to high value, potentially underutilized services by Medicare beneficiaries.
  • Ratesetting and Conversion Factor
    • Considering the budget neutral adjustments as required by law to ensure payment rates for services do not result in overall changes to Medicare spending, the required statutory update to the conversion factor for CY 2023 of 0%, and the expiration of the 3% increase in PFS payments for CY 2022, the proposed CY 2023 PFS conversion factor is $33.08, a decrease of $1.53 from the CY 2022 conversation factor of $34.61.
  • Medicare Economic Index
    • CMS proposed to rebase and revise the MEI cost-share weights for CY 2023 and proposed a new methodology for estimating base year expenses.
    • CMS also seeks public comment on the use of the proposed updated MEI cost-share weights to calibrate payment rates and update the GPCI in the future.
  • CY 2023 PFS Estimated Impact on Total Allowed Charges
COPA gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==