CMS Releases Medicare Physician Fee Schedule Final Rule for Calendar Year 2024
On November 2nd, the Centers for Medicare & Medicaid Services (CMS) published the Medicare Physician Fee Schedule final rule without comment period for calendar year (CY) 2024.
The final rule updates payment rates and policy changes for services effective on or after January 1, 2024. The final rule also includes updates for the Quality Payment Program (QPP), and will be published in the Federal Register on November 16, 2023.
- Conversion Factor. The final conversion factor for CY 2024 is $32.7442,* a reduction of 3.4% from the current conversion factor of $33.8872. (*Please note that Table 116 in the final rule indicates the wrong conversion factor. CMS has confirmed that the correct conversion factor for CY 2024 is $32.7442.) HRS will continue to advocate to Congress to avert the fee schedule cut and stabilize payment for Medicare physician services through ongoing support of H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which would provide a permanent, annual update equal to the increase in the Medicare Economic Index (MEI) to allow physicians to invest in their practices and implement new strategies to provide high-value care.
- Estimated Impact on Total Allowed Charges by Specialty
For CY 2024, CMS estimates the overall impact of RVU changes to cardiology services to be zero across facility settings (Tables 118 and 119). However, the actual impact of total Medicare revenues will differ based on geographic location, patient volume and mix of services.
- Deletion of G2066
CMS finalized its proposal to delete the technical component HCPCS code G2066, and accept the RUC-recommended direct practice expense (PE) inputs for CPT codes 93297 and 93298. CMS also corrected a clerical error in the equipment (EQ198) minutes for both codes (from 22 to 29 minutes and from 58 to 65 minutes, respectively). In our comment letter on the proposed rule, HRS commended the Agency on its decision to delete G2066 which had been contractor priced since CY 2020.
Last year, payment for G2066 was cut nearly 90%, threatening patient access to this life-saving service. In January, HRS and ACC met with the Medicare Administrative Contractor (MAC) Pricing Workgroup and CMS to advocate for a pricing methodology consistent with the cost of providing remote cardiac rhythm monitoring services. Deletion of G2066 will stabilize payment for high-risk patients with implantable cardiovascular physiologic monitoring systems and implantable loop recorder systems.
- Phrenic Nerve Stimulation System Codes
CMS finalized its proposal to accept RUC- recommended work RVU and PE inputs for eight new Category I CPT codes (33276-33288), to describe insertion, repositioning, removal, and removal/replacement, and four new CPT codes (93150-93153) for activation, interrogation, and programming of a phrenic nerve stimulation system. The new Category I CPT codes will replace the current Category III codes 0424T-0436T. CMS also corrected an error in the number of minutes for 33287 (from 36 to 53 minutes) to conform to changes in clinical labor time minutes. In our comments responding to the proposed rule, HRS asked that CMS finalize the RUC-recommended work and PE RVUs for this family of codes.
- Add-on Ablation CPT codes 93655 and 93657
Despite HRS opposition, CMS finalized its proposal to maintain the current work RVUs of 5.50 for add-on ablation CPT codes 93655 and 93657, instead of accepting the RUC-recommended work RVU of 7.00. CMS disagreed with the HRS position that these services are potentially misvalued, and continues to state that the current work RVU is appropriate for the 60 minutes of physician service time for both codes. However, CMS will continue to monitor this issue and the Medicare claims data for these codes in the coming years.
- Split or Shared E/M Visits
For CY 2024, in consideration of the changes made by the CPT Editorial Panel for evaluation and management (E/M) visits, and for billing purposes, CMS is revising the definition of "substantive portion" of a split (or shared) E/M visit. The definition of "substantive portion" means more than half of the total time spent by the physician and non-physician provider performing the split (or shared) visit, or a substantive part of the medical decision making (MDM), as defined by CPT. In our comments on the proposed rule, HRS reiterated the request for CMS to permanently modify the policy to allow E/M visits to be selected based on time or MDM.
- Introduction of G2211.
As proposed, CMS will begin payment for HCPCS code G2211, triggering a significant budget neutrality adjustment on the CY 2024 conversion factor. G2211 is an add-on code that can be listed separately in addition to office/outpatient E/M visits for new or established patients (99202-99215) with complex medical conditions. The code was finalized in 2021, but Congress suspended implementation for three years due to the estimated increase in fee schedule spending and impact on the conversion factor. In the proposed rule comment letter, HRS opposed introduction of G2211 since it generates a 2.0% conversion factor reduction.
- Appropriate Use Criteria for Advanced Diagnostic Imaging Program.
CMS finalized the proposal to pause efforts to implement the Appropriate Use Criteria (AUC) program for advanced diagnostic imaging. CMS is rescinding the current AUC program regulations and will continue efforts to identify a workable implementation approach, and any such approach would be proposed through subsequent rulemaking. The AUC program, mandated by the Protecting Access to Medicare Act of 2014 (PAMA), requires the ordering and performing physicians to use clinical decision support mechanism (CDSM) tools for advanced diagnostic imaging services and cannot be eliminated without legislative action. HRS supported the proposal in our comment letter on the proposed rule.
- Telehealth Services
CMS finalized proposals to add health and well-being coaching services to the Medicare Telehealth Services List on a temporary basis for CY 2024, and social determinants of health risk assessments on a permanent basis. CMS made changes to refine the process for review of requests to add services to the list, including a determination on whether the requested services should be added permanently or provisionally. In addition, CMS will implement several telehealth-related provisions authorized by the Consolidated Appropriations Act, 2023, including the temporary expansion of the originating sites for services to recognize any site in the United States where the beneficiary is located at the time of the telehealth service, including an individual's home.
- 2024 Merit-Based Incentive Payment System (MIPS) Performance Threshold
In our proposed rule comments, HRS strongly urged CMS not to finalize its proposal to increase the MIPS performance threshold, which is the minimum number of points needed to avoid a penalty, from 75 points to 82 points for the 2024 performance year. CMS estimated that this proposal could have resulted in over 50% of clinicians receiving a Medicare payment penalty in 2026. In the final rule, CMS listened to HRS and other stakeholders and opted to maintain a threshold of 75 points for 2024. This will make it less challenging for clinicians to avoid a penalty in 2026.
- Advancing Care for Heart Disease MIPS Value Pathway (MVP)
In our proposed rule comments, HRS asked CMS to finalize the addition of several quality measures to the Advancing Care for Heart Disease MVP, which would make the MVP a more viable MIPS reporting option for electrophysiologists. In the rule, CMS finalized these measures, as proposed. Download this file and other finalized MVPs for 2024.
In addition, CMS has provided the following resources related to the final rule: