The Centers for Medicare and Medicaid Services (CMS) has released the 2023 Medicare Physician Fee Schedule proposed rule and fact sheet. The rule once again features more payment cuts setting up another scenario for Congress to intervene. 

Conversion Factor 

For 2023, CMS is proposing a conversion factor of $33.08, compared to $34.61 in 2022. Part of the reason for this decrease is the expiration of the 3% increase added to the 2022 fee schedule by Congress. Additionally, budget neutrality changes stemming from clinical labor costs and value increases to the rest of the evaluation and management code set add to the reduction.  

Evaluation and Management Services

In the proposed rule, CMS has accepted the changes the AMA CPT® Editorial Panel is making to the remainder of the evaluation and management codes, bringing the requirements for the codes in line with the changes previously made to office visits (99201-99215). The changes will go into effect in 2023. 

Telehealth 

The services on the telehealth list only through the end of the current public health emergency will now be extended by 151 days, or an additional five months. The codes on this list notably include the CPT® codes for telephone visits.

Percutaneous Endovascular Repair of Pulmonary Artery Stenosis (PAS) by Stent Replacement 

In the proposed rule, CMS has valued a new CPT® code family for percutaneous endovascular repair of pulmonary artery stenosis (PAS) by stent replacement. However, CMS did not accept AMA RUC value recommendations. 

Pulmonary Angiography 

In the proposed rule, CMS has valued four new CPT® add-on codes for pulmonary angiography. However, CMS did not accept AMA RUC value recommendations. 

Merit-Based Incentive Program (MIPS) 

CMS has proposed no changes to the performance threshold for the 2023 performance year. It will remain at 75 points. However, the data completeness threshold will increase to 75 percent for the 2024 and 2005 performance years. 

CMS has proposed several changes to the Cardiology Specialty Measures set. The rule proposes adding three measures: Measure 187 Stroke and Stroke Rehabilitation: Thrombolytic Therapy, an equity measure Screening for Social Drivers of Health, and Adult Immunization Status. CMS is also proposing to remove three measures: Measure 110 Preventive Care and Screening: Influenza Immunization, Measure 111 Pneumococcal Vaccination Status for Older Adults, and Measure 323 Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Routine Testing After Percutaneous Coronary Intervention (PCI). 

MIPS Value Pathways (MVPs) 

CMS has proposed changes to the Advancing Care for Heart Disease MVP to be more inclusive of subspecialists. To do so, CMS is proposing seven additional quality measures and one new improvement activity be added to the MVP.  The quality measures include Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy, Functional Status Assessments for Heart Failure, and Risk-Standardized Acute Unplanned Cardiovascular-Related Admission Rates for Patients with Heart Failure for the Merit-based Incentive Payment System. 

CMS is accepting public comment on the proposed rule for 60 days from the final publication date. SCAI will continue to analyze the rule and will provide comments to CMS. 

SCAI continues to fight the payment cuts through both regulatory and legislative channels. SCAI’s Government Relations Committee and its political arm, SCAI PAC, will be reviewing the effects of these cuts and providing more information to SCAI members for further action in the near future.