November 3, 2022
On November 1, the Centers for Medicare & Medicaid Services (CMS) released the 2023 Medicare Physician Payment Schedule final rule, which includes improvements to the evaluation and management codes (E/M), but results in a reduction of the conversion factor (CF).
Notably, CMS adopted the revised CPT guidelines and codes and the AMA/Specialty Society RVS Update Committee (RUC) recommended increase to the relative values for E/M visit codes, which would allow descriptors and documentation standards that directly address the administrative burden for physicians in nearly every specialty, from across the country.
In total, the E/M code sets being revised for 2023 comprise approximately 20 percent of all allowed charges under the Medicare Physician Payment Schedule. Therefore, due to the statutory requirement for budget neutrality, these changes will require a reduction to the 2023 Medicare conversion factor.
Under the new rule, the CY 2023 Medicare conversion factor (CF) is $33.06, a decrease of $1.55 or 4.5% from the 2022 CF of $34.61. The decrease is largely a result of an expiring 3% increase funded by Congress through 2022 and the 1.6% decrease caused by the E/M increases.
The MMA signed on to the AMA letter that asked Congress to stop this payment cut and implement an inflationary update for physicians. The letter also asks:
for an extension of the 5% advanced APM incentive
to prevent the steep increase to the participation requirements for APMs; and
to waive the 4% PAYGO sequester.
In response to the Consolidated Appropriations Act, which extended payment for telehealth services to all communities in the country, not just rural areas, and allowed patients to receive telehealth services in their home for 151 days, or five months, after the end of the COVID-19 public health emergency (PHE) ends, CMS finalized its proposal to extend telehealth coverage for the codes that were only going to be on the telehealth list through the end of the PHE for an additional five months.
To see the rule and supporting documents from CMS click on the links below.
CMS MSSP Fact Sheet
If you have questions or would like more information, please contact Adrian Uphoff, Policy Analyst.
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