CMS Announces Medicare 2023 Physician Fee Schedule Final Rule
CMS Announces Medicare 2023 Physician Fee Schedule Final Rule
The press release announcing the final rule for the CMS CY 2023 Physician Fee Schedule (PFS) and Quality Payment Program was issued on November 1, 2022.
Please visit the CMS website to view the full CY 2023 Physician Fee Schedule and Quality Payment Program final rule.
By way of the Centers for Medicare & Medicaid Services (CMS), the U.S. Department of Health and Human Services (HHS) will expand access to these services:
- Behavioral health care
- Cancer screening coverage
- Dental care
In addition, the final rule promotes reform to the Accountable Care Organization program.
Payment Rates for CMS CY 2023 Physician Fee Schedule
The CY 2023 PFS conversion factor is $33.06. Due to budget neutrality adjustments (required by law), this is a decrease of $1.55 to the CY 2022 PFS conversion factor of $34.61.
Coverage for Behavioral Health Services and Opioid Use Disorder Treatment
CMS is making it easier for Medicare beneficiaries to get behavioral health services by:
- Allowing behavioral health clinicians (licensed professional counselors, marriage, and family therapists) to offer services under general supervision of the Medicare practitioner
- Paying for clinical psychologists and licensed clinical social workers to furnish integrated behavioral health care as part of a primary care team
- Providing monthly payment for comprehensive treatment and management services for patients with chronic pain
Medicare will pay for Opioid Treatment Programs using telecommunications with patients to initiate treatment with buprenorphine and allow treatment services provided through mobile units, such as vans, thus increasing access in rural and other underserved areas.
Expanding and Enhancing Accountable Care
The nation’s Accountable Care Organization program covers over 11 million people with Medicare and includes more than 500,000 healthcare providers. CMS is stepping toward a 2030 goal of having 100% of Traditional Medicare beneficiaries in an accountable care relationship with their healthcare provider.
Reducing Barriers and Expanding Coverage for Colon Cancer Screening
The minimum age for colorectal cancer screening is reduced from 50 to 45 years to reduce colon and rectal cancer deaths. Medicare will also cover as a preventive service a follow-on screening colonoscopy after a non-invasive stool-based test returns a positive result.
Finalizing Payment for Dental Services that are Integral to Covered Medical Services
CMS is organizing current policies to pay for dental services when the service is integral to treating a beneficiary’s medical condition and will establish annual processes to review input from the public regarding other circumstances when payment for dental services may be allowed.
Medicare will also pay for:
- Dental examination and treatment in more circumstances, e.g., to eliminate infection preceding an organ transplant and certain cardiac procedures (beginning in CY 2023) and prior to treatment for head and neck cancers (beginning in CY 2024).
Evaluation and Management (E/M) Visits
To reduce administrative burden, the AMA CPT Editorial Panel approved revised coding and updated guidelines for Other E/M visits, effective January 1, 2023. This change is similar to the changes made in office/outpatient E/M visit coding and documentation made in 2021.
CMS 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. CMS finalized the proposal to maintain the current billing policies that apply to the E/Ms while considering potential revisions that might be necessary for future rulemaking.
CMS also finalized the creation of Medicare-specific coding for payment of Other E/M prolonged services, like what CMS adopted in CY 2021 for payment of Office/Outpatient prolonged services – reporting these services with separate Medicare-specific G codes.
More Information
Review the CY 2023 Physician Fee Schedule Final Rule fact sheet.
See the final changes to the CY 2023 Quality Payment Program fact sheet.
Additional Updates
