Medicare Physician Fee Schedule Highlights

Conversion Factor 

For 2024, CMS finalized a conversion factor of $32.74 compared to $33.08 in 2023. The Senate Finance Committee has set forth a discussion draft that includes a 1.25 percent increase to the physician fee schedule that would help offset this reduction. 

G2211  

CMS finalized its proposal for an add on code, G2211, to be used in addition to evaluation and management services for additional complexity stemming from ongoing care of complex chronic conditions. SCAI will issue a detailed guidance document on how this code may be used. 

Telehealth 

The services on the telehealth list only through the end of the current public health emergency will be extended through December 31, 2024, along with the provision for site of service to include the patient’s home. Services rendered in the home and billed with place of service code 10 will continue to be paid at the non-facility, office-based rate. 

Venography 

After advocacy from SCAI, CMS finalized the RUC recommendations for all five new CPT® add on codes for venography.  

Percutaneous Transluminal Coronary Lithotripsy 

CMS finalized its value for a new CPT add on code for percutaneous transluminal coronary lithotripsy. CMS accepted the AMA RUC value recommendation. 

Transcatheter Heart Valve Procedures 

SCAI requested that CMS review their policies for co-surgeons, team surgeons, and assistant surgeons for transcatheter mitral valve and tricuspid valve Category III CPT procedure codes. CMS agreed to make the following policy indicator changes to allow co-surgeons, team surgeons, and assistant surgeons for these procedures: 

1. Change the assistant surgeon payment policy indicator from “0” to “2” for the following transcatheter valve procedure codes; 0483T, 0544T, 0545T, 0569T, 0570T and 0646T.
2. Change the co-surgeon payment policy indicator from “0” to “1” for transcatheter valve procedure codes 0544T, 0545T, 0569T and 0570T, and to “2” for CPT code 0646T.
3. Change the team surgeon payment policy indicator from “0” to “1” for CPT code 0646T.

Merit-Based Incentive Program (MIPS) 

CMS will not implement the proposed changes to the performance threshold for the 2024 performance year. CMS originally proposed an increase from 75 points to 82 points. Based on public feedback, CMS finalized the performance threshold for 2024 to remain at 75 points. 

SCAI continues to fight the payment cuts through both regulatory and legislative channels including the support of H.R. 3674, the Providing Relief and Stability for Medicare Patients Act of 2023, which would help to offset the cuts. SCAI’s Government Relations Committee and its political arm, SCAI PAC, will be monitoring Congressional action and providing more information to SCAI members for further action in the near future.  

Outpatient Prospective Payment System Highlights

CMS finalized a 3.1% increase to hospital outpatient and ambulatory surgical center rates for 2024.