CMS Releases Medicare Physician Fee Schedule Final Rule

November 6, 2023

On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) released the calendar year 2024 Medicare Physician Fee Schedule. Policies described in the rule will go into effect on January 1, 2024. AAPM&R submitted detailed comments to CMS regarding their proposed rule in September.

The rule finalizes a 3.37% reduction to the Conversion Factor, decreasing from the 2023 rate of $33.89 to $32.74. AAPM&R will be focusing our advocacy efforts on averting this payment cut during the remainder of 2023. Simultaneously, we are supporting legislative efforts to enact broader payment reform to put a stop to these annual cuts and pushing for reform of the current budget neutrality policies.

AAPM&R has successfully advocated on this issue:

• CMS has finalized 2024 requirements for split (or shared) E/M visits, aligning with policy recommendations AAPM&R has made over the last two years. CMS is implementing a new definition of “substantive portion,” which defines the provider who can bill for split (or shared) visits. In the new definition, the substantive portion is either based on time (more than half the encounter) or medical decision making as defined by CPT. In the coming weeks, AAPM&R will develop educational materials to help our members implement this change.
• CMS has also finalized its proposal to rescind the Appropriate Use Criteria program, a program which would have added significant burden to the ordering of advanced imaging services. AAPM&R has advocated for the elimination of this program for the past several years, citing the negative impacts of administrative burden on our physician members.
• CMS chose not to finalize their proposed increase to the Merit-based Incentive Payment System (MIPS) performance threshold. Consistent with AAPM&R’s advocacy on this issue, CMS will maintain the performance threshold at 75 points in 2024 rather than increasing to the proposed threshold of 82 points. We are pleased that CMS acknowledged the challenges providers would face if the threshold were to increase in 2024.

We are reviewing the rule in further detail and will be preparing additional summary information for members in the weeks to come, including specific information about payment rates for physiatry services. The rule includes new policies related to telehealth, new coding opportunities for E/M visits with complex patients and for caregiver training services, as well as updates to several important quality programs.

Members attending the 2023 Annual Assembly in New Orleans are encouraged to attend the AAPM&R Advocacy Priorities session on Saturday, November 18 at 10:45 am (CT) to learn more about the Academy’s reimbursement advocacy efforts in 2023 and agenda for 2024. Members practicing in the inpatient setting are also encouraged to attend our Inpatient E/M Coding session on Saturday, November 18 at 9:15 am (CT). Virtual attendees will also be able to view these sessions once they are posted to our online platform. Register now for the Annual Assembly.