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CMS Releases 2023 Medicare Physician Fee Schedule Final Rule

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Nov 16, 2022

On November 1, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule (MPFS) final rule for CY 2023. The rule updates payment policies and payment rates for Part B services furnished under the MPFS, as well as makes changes to the Quality Payment Program (QPP). The rule in its entirety, the addenda, including Addendum B, which lists the final RVUs for each CPT code, can be found here.

Policy Highlights from the Final Rule

Financial Impact

  • Unless Congress acts before the end of the year, the conversion factor for 2023 will decrease by 4.5% from $34.61 to $33.06. The conversion factor includes required budget neutrality adjustments, a mandated 0% update to the conversion factor and the expiration of the 3% increase to payments that was enacted last year. SGO submitted comments to CMS encouraging the agency to work with Congress to mitigate the payment cuts.
  • Many of the services billed to Medicare by gynecologic oncologists will see a decrease in payments ranging from 3% to 5%. This decrease is due to the change in the conversion factor and budget neutrality adjustments that are required by law. Note that the impact of policy changes varies among providers, depending on practice type, practice size, mix of patients and other factors.
  • For the specialty of gynecologic oncology, the most frequently billed codes under the Medicare program are evaluation and management (E/M) services. Many of those services will also see decreases in total payments for 2023 due to the decrease in the conversion factor and budget neutrality adjustments.

Evaluation and Management Services

  • CMS finalized revisions to the inpatient/observation E/M codes which include changes to the documentation guidelines that will now mirror the changes made to the outpatient E/M service codes in 2020.
  • Beginning on January 1, 2023, the code level billed for an inpatient/observation E/M may be chosen by time spent with the patient or medical decision making (MDM).
  • CMS accepted all the AMA RUC recommended values for the inpatient and observation codes, which was a mixed bag of winners and losers.
  • For example, the work RVU for an initial inpatient, high level MDM decreased by 9% from 3.86 to 3.50 work RVUs, while the work RVUs for a subsequent inpatient visit with the highest level of MDM increased by 20% from 2.00 to 2.40 work RVUs.
  • CMS finalized the use of G-codes to report prolonged services for Medicare patients. The new G-codes are to be used in lieu of the CPT codes created by the AMA CPT Editorial Panel. For example, for prolonged services associated with initial or subsequent inpatient E/M services, the provider should bill code G0316 instead of CPT code 99418.

Split/Shared Evaluation and Management
The final rule delays until 2024 the previously finalized split/shared policy that the provider who bills for a split/shared service should be the provider who spent the substantive portion of time (defined as more than half of the total time) with the patient. However, in 2023, just as in 2022, the billing provider may be determined by which provider performed the history and physical exam or conducted the MDM, or it may be determined by which provider spent more than half the total time with the patient.
SGO submitted comments supporting a delay in the policy and recommending the agency “use this time to collaborate with providers to ensure that this policy does not negatively impact team-based care. High quality cancer care delivery typically involves a team, and once the policy is finalized, it should not undermine the delivery of collaborative care.”

Health Equity Measures Finalized
Addressing health equity is a priority for the agency. One way to do this is by tracking quality measures meant to address social drivers of health. As such, CMS created and finalized two measures for potential inclusion in the Merit-based Incentive Payment System (MIPS).

  • MUC21-136: Screening for Social Drivers of Health
  • MUC21-134: Screen Positive Rate for Social Drivers of Health

CMS received wide support for the inclusion of these measures, including support from SGO. While the measures are not currently active, the agency will consider the positive feedback in future rule making.

For questions about policies finalized in the rule, please contact Katie Martino, SGO’s Manager of Governance and Clinical Practice.