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CMS Releases Proposed Rule for 2023 Medicare Physician Fee Schedule and Quality Payment Program

Wednesday, August 3, 2022

On July 7, 2022 the Centers for Medicare and Medicaid Services (CMS) released the Proposed Rule for the Calendar Year 2023 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP). CMS is currently soliciting public comments on the proposed rule until September 6, 2022. The Michigan State Medical Society (MSMS) is reviewing the impact of the proposed changes and will be submitting comments on the draft rule.

CMS has released a fact sheet on the proposed rule and the American Medical Association (AMA) has prepared a summary. As reported in AMA’s the summary, the proposed rule covers diverse topics, including the CY 2023 Rate Setting and Medicare Conversion Factor, Evaluation/Management (E/M) services, telehealth and other services involving communications technology, and updates to the Quality Payment Program through Merit-based Incentive Payment System (MIPS) activities, methodology, payment adjustments, amongst other provisions. Below are some key highlights from the proposed rule:

  • CY 2023 PFS Rate Setting and Medicare Conversion Factor (CF) CMS is proposing a CY 2023 Medicare conversion factor (CF) of $33.0775, a decrease of $1.53 or 4.42 percent from the 2022 CF rate of $34.6062. The decrease comes as a result of budget neutrality adjustments and expiration of the 3 percent increase to the CF in CY 2022.
  • Evaluation and Management (E/M) Visits – The draft rule includes changes in coding and documentation for Other E/M code sets which include hospital inpatient, hospital observation, emergency department, nursing facility, home or residence services, and cognitive impairment assessments, effective January 1, 2023. The changes are similar to the changes made in the CY 2021 PFS final rule for office/outpatient E/M visit coding and documentation that allowed physicians to select the E/M visit level to bill based on either total time spent on the date of patient encounter or the medical decision making utilized in the provision of the visit.
  • Split (or Shared) E/M Visits – CMS is proposing a one-year delay of its split (or shared) E/M visits policy which was finalized in CY 2022. The policy requires 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. Under the proposal, physicians would continue to bill split or shared visits based on the current definition of substantive portion as one of the following: history, exam, medical decision-making, or more than half of total time through calendar year 2023.
  • Telehealth and Other Services Involving Communications Technology – The draft rule includes a number of provisions related to Medicare telehealth services and their availability beyond the COVID-19 Public Health Emergency (PHE). Codes in Category III of the Medicare Telehealth List are being covered on an interim basis until data can be gathered to determine whether they should become Category I or II services or be removed from coverage. CMS is proposing these Category III services be covered through CY 2023. The draft rule recommends that telehealth services temporarily included on the telehealth services list during the PHE, but are not included on a Category I, II, or III basis continue to be covered for a period of 151 days (5 months) following the end of the PHE, in accordance with the Consolidated Appropriations Act of 2022. Additional provisions from the Consolidated Appropriations Act of 2022 are also proposed to be implemented. This includes extending certain telehealth flexibilities related to originating site, geographic, and telecommunication system requirements for an additional 151 days (5 months) after the end of the PHE.
  • Electronic Prescribing of Controlled Substances (EPCS) – CMS is set to begin compliance enforcement of the requirement for EPCS in 2023. Compliance in the first year of enforcement (CY 2023) will involve letters being sent to noncompliant prescribers urging them to adopt EPCS. CMS is proposing to extend the letter phase of compliance through CY 2024. CMS plans to begin increasing the severity of penalties for noncompliant prescribers starting in CY 2025 and is seeking comments on potential penalties for noncompliance. CMS is also proposing aligning its actions with the availability of data by using current year prescription drug event (PDE) data to evaluate current year compliance, rather than PDE data from the preceding year. (Note: Michigan’s electronic prescribing requirement’s enforcement is set to coincide with CMS’s enforcement schedule. MSMS is closely following the issue and will provide guidance to practices when available.)
  • Chronic Pain Management – CMS is proposing a new monthly bundled payment for chronic pain management. The proposed chronic pain management codes would include the following:  diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and maintenance of a person-centered care plan that includes strengths, goals, clinical needs and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and coordination between relevant practitioners furnishing care, such as physical and occupational therapy and community-based care, as appropriate.
  • Expansion of Coverage for Colorectal Cancer Screening and Reducing Barriers – The proposal includes expansion of Medicare coverage for colorectal cancer screening tests by reducing the minimum age payment limitation from 50 to 45 years to be consistent with new recommendations from the United States Preventive Services Task Force (USPSTF). CMS is also proposing to expand the definition of colorectal cancer screening test to include a follow-up screening colonoscopy after a positive result on a Medicare covered non-invasive stool-based colorectal cancer screening.

Questions or comments regarding the Proposed Rule can be directed to Mary Kate Barnauskas.