Navigating The 2023 CMS Physician Fee Schedule, Look Up

The final 2023 Medicare Physician Fee Schedule (MPFS) has released by the Centers for Medicare and Medicaid Services (CMS) on November 1. 2022. It included the upgradation of key factors such as Medicare payment and quality provision. This proposal has reduced the fee schedule conversion factor from $34.6062 to $33.0607, which means a 3% of supplemental increase in fee schedule payments for CY 2022.

Updates related to telehealth flexibilities, which mirror components of the 2022 Consolidated Appropriations Act, are also considered in this new outlook. CMS estimated that the new rule would decrease 1% payment for cardiologists compared with 2022 because of updates to work, practice expense, and malpractice relative value units (RVUs). This estimation could vary based on the cardiology profession and provided practices.

In addition, the 2023 MPFS features updated coding and work RVUs/practice expense RVUs for Evaluation and Management (E/M) and other services, as well as updates to the Quality Payment Program and Medicare Shared Savings Program. The revised E/M services will be based on the level of the MDM or the total time for the E/M service performed on the date of the encounter. The 2023 RVUs for global surgical packages are believed to be erroneous, and CMS invited public feedback on possible improvements to the valuation of these packages. However, the Appropriate Use Criteria (AUC) Program has not undergone any adjustments from CMS.

As part of the final rule, CMS has altered its earlier proposed work RVUs for electrophysiology (EP) ablation services. For SVT, VT, and AF ablation, CMS will use RVUs that are higher than those suggested by the American Medical Association (AMA) Relative Value Scale Update Committee (RUC). Overall, these numbers are still below the 2022 work RVUs. In 2022 or the proposed rule, the RVUs for extra ablation services remained the same. The 2023 RVUs tables for this family of codes will be 11.2% higher by adopting the RUC guidelines for the primary ablation services and 3.7% lower by 2022.

It is essential for healthcare providers to stay up-to-date on the latest changes and updates in the 2023 CMS Physician Fee Schedule to navigate it effectively. With reductions in the fee schedule conversion factor, updates to telehealth flexibilities and coding for E/M services, and delays to the split (or shared) visits policy, healthcare providers must be aware of the changes to ensure that their services are properly reimbursed.