On November 1st, 2022, the Centers for Medicare and Medicaid Services (CMS) issued the calendar year (CY) 2023 physician fee schedule (PFS) final rule. Below is a high level overview of some of the information taken directly from the CMS CY 2023 Fact Sheet.
CY 2023 PFS Rate Setting and Conversion Factor
Budget neutrality adjustments are required by law to ensure payment rates for individual services don’t result in changes to estimated Medicare spending. The required statutory update to the conversion factor for CY 2023 of 0%, and the expiration of the 3% supplemental increase to PFS payments for CY 2022, the final CY 2023 PFS conversion factor is $33.06, a decrease of $1.55 to the CY 2022 PFS conversion factor of $34.61.
Telehealth Services
For CY 2023, CMS finalized a number of policies related to Medicare telehealth services, including making several services that are temporarily available as telehealth services for the PHE available at least through CY 2023 in order to allow additional time for the collection of data that may support their inclusion as permanent additions to the Medicare Telehealth Services List.
CMS finalized their proposal to extend the duration of time that services are temporarily included on the telehealth services list during the PHE for at least a period of 151 days following the end of the PHE, in alignment with the Consolidated Appropriations Act, 2022 (CAA, 2022). This finalization includes:
- Allowing telehealth services to be furnished in any geographic area and in any originating site setting (including the beneficiary’s home);
- Allowing certain services to be furnished via audio-only telecommunications systems; and
- Allowing physical therapists, occupational therapists, speech-language pathologists, and audiologists to furnish telehealth services.
Chronic Pain Management and Treatment Services (CPM)
CMS finalized new HCPCS codes, G3002 and G3003, and valuation for chronic pain management and treatment services (CPM) for CY 2023. CMS believes the CPM HCPCS codes will improve payment accuracy for these services, prompt more practitioners to welcome Medicare beneficiaries with chronic pain into their practices, and encourage practitioners already treating Medicare beneficiaries who have chronic pain to spend the time to help them manage their condition within a trusting, supportive, and ongoing care partnership.
The finalized codes include a bundle of services furnished during a month that CMS believes to be the starting point for holistic chronic pain care, aligned with similar bundled services in Medicare, such as those furnished to people with suspected dementia or substance use disorders. CMS has finalized the CPM codes to include the following elements in the code descriptor:
- diagnosis;
- assessment and monitoring;
- administration of a validated pain rating scale or tool;
- the development, implementation, revision, and/or 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, complementary and integrative care approaches, and community-based care, as appropriate.
Audiology Services
CMS finalized a policy to allow beneficiaries direct access to an audiologist without an order from a physician or NPP for non-acute hearing conditions. The finalized policy will use a new modifier ─ instead of using a new HCPCS G-code as we proposed ─ because CMS was persuaded by the commenters that a modifier would allow for better accuracy of reporting and reduce burden for audiologist.
The service(s) can be billed using the codes audiologists already use with the new modifier and include only those personally furnished by the audiologist. The finalized direct access policy will allow beneficiaries to receive care for non-acute hearing assessments that are unrelated to disequilibrium, hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids. This modification in CMS’ finalized policy necessitates multiple changes to our claims processing systems, which will take some time to fully operationalize, but audiologists may use modifier AB, along with the finalized list of 36 CPT codes, for dates of service on and after January 1, 2023.
CMS finalized the proposal to permit audiologists to bill for this direct access (without a physician or practitioner order) once every 12 months per beneficiary. Medically reasonable and necessary tests ordered by a physician or other practitioner and personally provided by audiologists will not be affected by the direct access policy, including the modifier and frequency limitation.
Some other final rule information include: See CMS CY 2023 Fact Sheet for more information:
Evaluation and Management (E/M) Visits
Behavioral Health Services
Opioid Treatment Programs (OTPs)
Dental and Oral Health Services
Skin Substitutes
Colorectal Cancer Screening
Preventive Vaccine Administration Services
Source Document: CMS CY 2023 Fact Sheet