APMA Comments on CY2024 MPFS, QPP, and OPPS | News | APMA
APMA Comments on CY2024 MPFS, QPP, and OPPS

September 12, 2023

APMA submitted comments in response to CMS’ Medicare and Medicaid Programs: CY 2024 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment, etc., on September 11. APMA’s extensive comments focused on the following concerns, among others:

Medicare Physician Fee Schedule (MPFS) Conversion Factor

APMA is urging CMS to pursue opportunities to mitigate the impact of the proposed conversion factor reductions for 2024, including working with Congress to enact a legislative remedy. We further urge CMS to engage with Congress and stakeholders to develop and enact real reform to the Physician Fee Schedule (PFS) that ensures physicians can consistently rely on sustainable payments over the long term.

Evaluation and Management (E/M) Visits

CMS is planning to activate HCPCS G2211. APMA opposes CMS’ proposal to change the status indicator for G2211 to “active” and begin payment for this service for several reasons:

  • Instituting payment for G2211 will introduce disruptions to the resource-based relative value units (RVUs) under the PFS
  • Instituting payment for G2211 compromises the progress of recent improvements to E/M coding and will cause confusion among practitioners
  • Changes could unfairly impact practitioners who may not be able to utilize the code due to the need to maintain budget neutrality
  • The CPT code set already contains codes to represent services typically employed when providing ongoing care related to a patient’s single, serious condition or a complex condition.

Telephone E/M Services

APMA appreciates ongoing payment for telephone E/M services through 2024 and asks that this policy be made permanent. 

Appropriate Use Criteria for Advanced Diagnostic Imaging

APMA applauds and supports CMS’ proposal to pause efforts to implement the Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging Services program for reevaluation and to rescind the current AUC program regulations.

Payment for Skin Substitutes

APMA urges CMS to move away from its attachment to changing the methodology for paying for skin substitutes furnished in physician offices and treating them as “incident to supplies.” Instead, APMA believes CMS should continue its long-standing policy of recognizing and providing separate payment for these products under the ASP methodology described in section 1847A of the Social Security Act (SSA). ASP pricing would ensure that there is differentiated payment for differentiated products. Different products deliver different benefits to patients, and they vary in composition, cost, and size.

MIPS Performance Threshold for Experienced and New Participating Clinicians

CMS proposes to raise the MIPS performance threshold from 75 to 82 points. APMA believes that most clinicians who have not fully participated in MIPS since 2019 will find this goal to be unsurmountable. Under the rules set forth by Congress, CMS is only required to set the threshold at the mean or median of the final scores of all MIPS eligible clinicians from a “prior period” identified by CMS, meaning CMS has the authority already to maintain the performance threshold at 75 points for 2024. Given the reality of numerous recent exemptions and reduced participation in the program, APMA strongly urges CMS to maintain the performance threshold at 75 points and to work with Congress to find solutions that will give CMS more flexibility to determine the most appropriate performance threshold(s) for future years.  

APMA also submitted comments on the CY 2024 Proposed Rule on Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; etc. APMA, as a member of the Alliance of Wound Care Stakeholders, supported the comments of the alliance and asked CMS to implement the recommendations provided to and approved by the Advisory Panel on Hospital Outpatient Payment. These recommendations, if implemented by CMS, will help correct the flaws that exist in the payment methodology as well as inappropriate APC assignments for cellular and or tissue-based products for skin wounds (CTPs) which have impacted access to care in hospital outpatient departments (HOPDs). The recommendations included:

  1. Assign the existing CPT® add-on codes (15272, 15276, 15274, and 15278) and HCPCS codes (C5272, C5276, C5274, and C5278) to appropriate APC groups allowing for separate payment and issue an exception to separately pay for these add-on codes
  2. Assign the CPT and HCPCS codes for the same size wound, regardless of anatomical location on the body, to the same APC groups
  3. Assign all new CTPs with both Q and A HCPCS codes, to the low-cost APC groups until a manufacturer provides cost information to CMS
  4. Realign both the high-cost and low-cost application procedure codes to higher paying APC groups that reflect the current average sales prices of all CTPs
  5. Not assign CTPs that are not in sheet form (e.g., gel, powder, ointment, foam, liquid, or injected) to any APC group.

Read both comment letters in their entirety at www.apma.org/comments. Read the APMA Weekly Focus for additional updates and contact the APMA Health Policy and Practice Department with any additional concerns or comments.

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