News & Media

CMS Releases 2023 Medicare Physician Fee Schedule Final Rule

Wednesday, November 9, 2022

On November 01, 2022, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2023 Medicare Physician Fee Schedule (MPFS) final rule. This rule impacts payments for physicians and other health care practitioners and includes changes to the Merit-based Incentive Payment System and alternative payment model (APM) participation options and requirements for 2023.

Although the 2023 MPFS contains a number of helpful policies such as extending payment for telehealth services to all communities in the country and in any originating site setting through the duration of the public health emergency and for 151 days thereafter, there are several policies that are problematic. Most notably, CMS’s decision to finalize the CY 2023 Medicare conversion factor (CF) at $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 percent increase funded by Congress through 2022. The additional approximate 1.6 percent decrease is the result of budget neutrality requirements that stem from revised E/M changes.

The Michigan State Medical Society joins the AMA and other Federation members in strongly advocating that Congress avert this 3% payment cut which, without Congressional action is scheduled to start January 1, 2023. MSMS and others are also advocating for Congress to implement an inflationary update for physicians, extend the 5 percent APM incentive and prevent the steep increase to the participation requirements for APMs, and waive the 4 percent PAYGO sequester. You can help in this effort by sending a letter to your congressional members urging them to act swiftly to avert these significant payment cuts.

Other key highlights include:

  • Adopts the revised CPT guidelines and codes and the AMA/Specialty Society RVS Update Committee (RUC) recommended relative values for additional E/M visit code families, including hospital visits, emergency department visits, home visits and nursing facility visits. These changes allow time or medical decision-making to be used to select the E/M visit level.
  • Imposes a one-year delay of CMS’s policy requiring a physician to see the patient for more than half of the total time of a split or shared E/M visit in order to bill for the service. This action will continue to allow physicians and qualified health care professionals to use history, physical exam, medical decision making (MDM), or more than half of the total time spent with a patient to determine the substantive portion of the split/shared visit in 2023.
  • Finalizes new HCPCS codes, G3002 and G3003, and valuation for chronic pain management and treatment services (CPM) for CY 2023 and provided some additional flexibilities, such as the ability to report CPM and other visits on the same date and to report subsequent CPM services as many times as needed in a month.
  • Expands Medicare coverage for colorectal cancer screening in order to align with recent United States Preventive Services Task Force and professional society recommendations.
  • Maintains the MIPS performance threshold at 75 points for the 2023 MIPS performance year (2025 payment year).
  • Adds five new MIPS Value Pathways related to nephrology, oncology, neurological conditions, and promoting wellness, for voluntary reporting beginning in 2023.
  • Creates an advanced incentive payment pathway for certain low-revenue, new entrant accountable care organizations to bolster participation in the Medicare Shared Savings Program.

Please see the following documents for more information: