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2024 Medicare Physician Fee Schedule Released in Early November

News Article
Nov 27, 2023

On November 2, the Centers for Medicare & Medicaid Services (CMS) released a final rule that updates payment policies for the Calendar Year (CY) 2024 Medicare Physician Fee Schedule. CMS finalized a decrease in the conversion factor of approximately 3.37% from $33.89 to $32.74. The agency implemented several significant changes, including payment for the practice expense associated with a pelvic exam using new CPT® code 99459, which captures four minutes of clinical staff time; payment for dental services inextricably linked to other covered services, including those for chemotherapy; and a new policy for reporting split/shared services in the facility setting.

SGO is very concerned about the decrease to the conversion factor. Without Congressional action, CMS does not have the authority to mitigate or eliminate this cut. SGO submitted comments on how continued cuts to physician payment affect the specialty of gynecologic oncology and continues to work with Congress and other stakeholders to reform physician payment policy.

CMS has also finalized coding and payment for several services of relevance to SGO members. CPT® 99459 – pelvic exam, is a direct practice expense only code that may be billed with E/M services when practitioners are providing a pelvic exam to patients during an E/M service. The code was created to capture the additional direct practice expense associated with a pelvic exam, including four minutes of clinical staff time associated with chaperoning, as well the additional supplies needed such as a speculum.

Also finalized are coding and payment for services that address health related social needs including new HCPCS codes;

– G0136 used to report the services associated with performing a social determinants of health (SDOH) risk assessment.

– G0019 and G0022 (community health integration services) used to report services that address the SDOH needs that interfere with, or present a barrier to, diagnosis or treatment of the patient’s problem(s).

– G0023 and G0024 describe principal illness navigation services which can be furnished following an initiating E/M visit addressing a serious high-risk condition/illness/disease expected to last longer than three months, such as cancer and other debilitating long-lasting illnesses.

Additionally, the agency will continue to pay for telehealth services at the non-facility rate for telehealth services performed in the Medicare beneficiary’s home. This will apply to telemedicine services delivered to Medicare beneficiaries until December 31, 2024, unless Congress passes legislation extending the waiver of or waiving permanently the originating site requirement. In addition, CMS finalized the use of virtual supervision using real-time audio-video telehealth services through the end of 2024. A more detailed analysis of the final rule is available here. A fact sheet and press release are also available for review.