CMS Finalizes Rate Cuts in 2023 Medicare Physician Fee Schedule

The Centers for Medicare & Medicaid Services (CMS) recently released the 2023 Medicare Physician Fee Schedule (PFS) final rule, effective Jan. 1, 2023. The rule reduces the PFS conversion factor by $1.55 (4.7%) to $33.06 in a calendar year (CY) 2023 from $34.61 in CY 2022, which reflects a required statutory update of 0% and the expiration of the one-year Congress-approved 3% increase in PFS payments for CY 2022. The finalized rule also includes changes in policies for telehealth, opioid use disorder, dental services, and the Medicare Shared Savings Program (MSSP).

The CMS finalized:

  • Expanding the telehealth category 3 codes list and extend coverage through Dec. 31, 2023
  • Modifying opioid treatment program payment rates that will increase overall payments for medication-assisted treatment and other treatments for opioid use disorder
  • Clarified that Medicare Fee-For-Service (FFS) payment for dental services when it is an integral part of treatment, such as dental exams and necessary treatment before organ transplants, cardiac valve replacements and valvuloplasty procedures
  • Making several changes to increase participation in the MSSP, including updates to benchmarks to sustain long-term participation and reduce costs. The CMS also updated quality measurement policies, including a new healthy equity adjustment that will award bonus points to accountable care organizations serving high proportions of underserved beneficiaries

Members with questions and feedback should contact Renée Smiddy at the MHA.