CMS Releases CY 2024 Proposed Rule for the Medicare Physician Fee Schedule

On Thursday, July 13, the CMS released the Calendar Year (CY) 2024 Medicare Physician Fee Schedule proposed rule and fact sheet. The SGO staff will review the provisions of the rule in the coming weeks and prepare comments, which are due September 11.

2024 Conversion Factor

The conversion factor for 2024 is set to decrease by approximately 3.36% from $33.8872 to $32.7476. The proposed conversion factor is the result of a statutory 0% update scheduled for the physician fee schedule in 2024, a negative 2.17% RVU budget neutrality adjustment, and a funding patch Congress passed at the end of 2022 through the Consolidated Appropriations Act of 2023 that partially mitigated a cut to the 2023 conversion factor, which then helped to offset reductions to the 2024 conversion factor.

Impact by Specialty

Table 104 of the rule, CY 2024 PFS Estimated Impact on Total Allowed Charges by Specialty outlines the changes to payments for specialties. Note that the impact to group practices and individual physicians varies based on geographic location, practice type, mix of patients and the types of services provided to those patients.

CMS Accepted RUC Recommendations for New CPT® Code

SGO members continue to provide valuable information for valuing new and revised CPT codes through the AMA RUC survey process. In the proposed rule, CMS provides information on values for pelvic exam and HIPEC services.

Pelvic Exam

At the September 2022 AMA CPT Editorial Panel Meeting, the Panel approved a new code to capture the practice expense of providing a clinical staff chaperone during a pelvic examination. The new CPT code 9X036 is a practice expense-only code, and therefore has no work associated with the service. As such, the code is valued with a PE RVU of 0.68 which captures four minutes of clinical staff time when chaperoning a pelvic exam. The code may be reported with evaluation and management services in the non-facility/office setting.

Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Due to issues with the AMA RUC Panel survey for services associated with HIPEC, the newly created codes will be priced at the Medicare Contractor level in 2024, meaning that each Medicare Administrative Contractor (MAC) may set the reimbursement level that they deem appropriate for these codes. Contractor pricing will remain in effect until 2025, until a new survey is completed and values for these services are recommended by the RUC.

Telehealth

CMS continues to support the use of telehealth, and as such has proposed changes to allow for greater access to these services. The agency is proposing a refined process to analyze requests received for services to be added to the Medicare Telehealth Services List, including whether the service should be added temporarily or permanently.

CMS is also proposing to implement several telehealth-related provisions of the Consolidated Appropriations Act of 2023, including the temporary expansion of the scope of telehealth originating sites for services furnished via telehealth to include any site in the United States where the beneficiary is located at the time of the telehealth service, including an individual’s home, and the continued coverage and payment of telehealth services included on the Medicare Telehealth Services List until December 31, 2024.

CMS is proposing that telehealth services provided to people in their homes be paid at the non-facility PFS rate. This proposal aligns with telehealth flexibilities that were included in the Consolidated Appropriations Act of 2023.

The agency has also proposed to allow direct supervision through real-time audio and video interactive communications through December 31, 2024.

Split/Shared Services

CMS has proposed to delay, yet again, the implementation of the definition of the “substantive portion” as more than half of the total time through at least December 31, 2024. CMS has proposed to allow the current definition of substantive portion to stay in effect for CY 2024, which allows for the use of either one of the three components, which include history, exam or medical-decision making or more than half of the total time spent to determine the provider who will bill for the visit.

Evaluation and Management (E/M) Services

CMS is implementing a separate add-on payment for healthcare common procedure coding system (HCPCS) code G2211, which will better recognize the resource costs associated with evaluation and management visits for primary care and longitudinal care of complex patients. This code will generally be applicable for outpatient visits as an additional payment that recognizes the costs that clinicians incur when treating a patient’s single, serious, or complex chronic condition.

CMS had originally finalized this policy in the CY 2021 MPFS final rule. However, Congress intervened and prohibited the policy from being implemented before January 1, 2024. CMS is proposing refinements to the policy, specifically that the add-on code would not be billed with a modifier that denotes an office and outpatient E/M visit that is unbundled from another service. The agency also modified the utilization estimates for the code, which lowered the overall impact on the payment system. In a budget neutral payment system such as the MPFS, changes in payment for one code may lead to decreases in payment for other codes. CMS lowered the usage estimation for G2211 which decreased the overall impact to other services.