U.S. CMS Releases CY 2023 Proposed Medicare Physician Fee Schedule
Friday, July 15, 2022
On July 7th, the Centers for Medicare & Medicaid Services released its CY 2023 Proposed Medicare Physician Fee Schedule.
Below are some highlights based on IPSIS’ early analysis.
2023 Conversion Factor
The proposed 2023 conversion factor is $33.08, a decrease of $1.53 (4.42%) from the
2022 Physician Fee Schedule conversion factor of $34.61. This is due to the expiration of the 3% increase in the PFS reimbursements in CY 2022 as required by the Protecting Medicare and American Farmers from Sequester Cuts Act, a 0.00% conversion
factor update, and a budget-neutrality adjustment.
CPT Code Valuations
IPSIS participated in the effort to survey the fluoroscopic and ultrasonic guidance codes. The
results of the survey and value recommendations were presented by society advisors at the October 2021 RUC meeting. CMS intends to accept the RUC recommended values for CPT codes:
76942 Ultrasonic guidance for needle placement
(eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation.
77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)
77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid)
Chronic Pain Management
For CY 2023, CMS is proposing to create two HCPCS G-codes to describe monthly CPM services that would separately pay for a specified set of CPM elements furnished
during a month. The codes, descriptors and proposed work values for the proposed G-codes are:
â—Ź HCPCS code GYYY1: Chronic pain management and treatment, monthly bundle
including, diagnosis; assessment and monitoring; administration
of a validated pain rating scale
or tool; the development, implementation, revision, and maintenance of a person-centered care
plan that includes strengths, goals, clinical needs, and desired outcomes; overall treatment
management;
facilitation and coordination of any necessary behavioral health treatment;
medication management; pain and health literacy counseling; any necessary chronic pain
related crisis care; and ongoing communication and care coordination between
relevant
practitioners furnishing care.
Proposed work RVU of 1.45
â—Ź HCPCS code GYYY2: Each additional 15 minutes of chronic pain management and
treatment by a physician or other qualified health care
professional, per calendar month
Proposed work RVU of 0.50
IPSIS staff is reading and analyzing the 2066-page rule and will provide comments on appropriate provisions by the September comment deadline. Additional information on the rule can
be found using the following CMS resources:
CMS Press Release
CMS PFS Fact Sheet
Not long before the final rules are released in the fall, experts will discuss coding changes, coverage policies, LCD documentation requirements, OIG activities and more at the IPSIS 2022 Annual Meeting in Vancouver, Canada.
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