The Centers for Medicare and Medicaid Services (CMS) has released the 2023 Medicare Physician Fee Schedule final rule and fact sheet. The rule finalizes the payment cuts proposed in July. 

Conversion Factor 

For 2023, CMS is finalizing a conversion factor of $33.06, compared to $34.61 in 2022. If Congress doesn’t act, the $1.55 cut is the steepest reduction to the conversion factor in twelve years. 

Evaluation and Management Services 

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). These changes will go into effect on January 1, 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.  

CMS continues to evaluate whether direct supervision via virtual presence should be a permanent policy, but the policy will be in place until at least the end of 2023. 

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

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. Despite advocacy from SCAI, CMS finalized its recommendations. 

Pulmonary Angiography 

CMS has valued four new CPT^® add-on codes for pulmonary angiography. However, CMS did not accept AMA RUC value recommendations. Due to SCAI advocacy, CMS did revise their decision on code 95369, increasing the value from .63 to .78 work RVUs. 

Merit-Based Incentive Program (MIPS) 

CMS has finalized 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 2025 performance years. 

CMS has finalized several changes to the Cardiology Specialty Measures set. The rule adds three measures: Measure 187 Stroke and Stroke Rehabilitation: Thrombolytic Therapy, and an equity measure 487, Screening for Social Drivers of Health, and 493, Adult Immunization Status. CMS is also removing 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 finalized changes to the Advancing Care for Heart Disease MVP to be more inclusive of subspecialists. To do so, CMS added seven quality measures and one new improvement activity 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. 

SCAI continues to fight the payment cuts through both regulatory and legislative channels. If you have any questions about the rule, please feel free to contact SCAI’s Manager of Coding and Reimbursement, Monica Wright at [email protected].