November 7, 2022

CMS released the CY 2023 Medicare Physician Fee Schedule (MPFS) Final Rule on Tuesday, November 1. APMA is reviewing the rule and will provide full analysis to members as necessary. CMS also released the CY 2023 Medicare Hospital Outpatient Prospective Payment System (OPPS) Final Rule.

CMS finalized its plan to reduce the CY 2023 Conversion factor from $34.61 to $33.06, or a decrease of 4.5 percent. This conversion factor reflects the statutorily required update of 0 percent for CY 2023, expiration of the temporary 3-percent supplemental increase in PFS payments for CY 2022 provided by the Protecting Medicare and American Farmers From Sequester Cuts Act, and the statutorily required budget neutrality adjustment to account for changes in payment rates. APMA is working with its partners in Congress and other medical specialty societies to push for Congressional intervention, and APMA urges DPMs to use APMA eAdvocacy to appeal to members of Congress to delay or cancel further cuts to Medicare reimbursement.

CMS elected to modify its planned overhaul of Cellular and/or Tissue-based Products Services for now. CMS had been proposing an overhaul of the nomenclature, coding, and payment of cellular and/or tissue-based products (CTP), also referred to as skin substitute products, effective January 1, 2024. Instead, CMS will conduct a Town Hall in early CY 2023 with interested parties to address stakeholder concerns as well as discuss potential approaches to the methodology for payment of skin substitute products under the PFS.

Additionally, the rule finalized several proposals of note:

• 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; finalized 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).
• Finalized and adopted most of the AMA CPT changes in coding and documentation for Other E/M visits (which include hospital inpatient, hospital observation, emergency department, nursing facility, home or residence services, and cognitive impairment assessment) effective January 1, 2023.
• Finalized a 2023 MIPS performance year threshold of 75 points. APMA encourages members to prepare for a possible scenario in which no COVID-related MIPS exceptions exist for the 2023 performance year.

For APMA’s previous comments on the proposed rule, visit www.apma.org/comments. For additional questions, contact APMA’s Health Policy and Practice Department at healthpolicy.hpp@apma.org.