CMS Releases Final 2023 Medicare Physician Fee Schedule and Hospital OPPS Rule

The Centers for Medicare and Medicaid Services (CMS) has released the 2023 Physician Fee Schedule Final Rule. Of note, the MPFS conversion factor has been updated from $34.6062 to $33.06, and the overall reimbursement for cardiovascular services is projected to decrease 1% compared with 2022, mostly driven by changes in practice expense payments. Individuals and groups will see different impacts depending on patient populations and services offered.

The rule also addresses updated code values for new/revised services, cyclical updates to the Quality Payment Program, implementation of the MIPS Value Pathways (MVPs) for CY 2023, and other payment policy proposals. Additionally, the rule includes technical revisions to split/shared billing changes and postpones implementation of those policies until Jan. 1, 2024.

Of note, CMS altered its earlier proposed work relative value units (RVUs) for electrophysiology (EP) ablation services as part of the Final Rule, following intense advocacy efforts from ACC, the Heart Rhythm Society (HRS), and other stakeholders. CMS will implement RVUs recommended by the AMA Relative Value Scale Update Committee (RUC) that are higher than the earlier proposal for SVT, VT, and AF ablation. These values are still lower, overall, than the 2022 work RVUs. RVUs for additional ablation services are unchanged from 2022 or the proposed rule.

"While the changes CMS made in response to feedback from the ACC and Heart Rhythm Society (HRS), members of Congress, and other stakeholders are appreciated, ACC and HRS remain disappointed that the agency did not go further in amending the proposed cuts for key electrophysiology ablation services to reflect higher values derived within the established RUC survey process, recognizing the high degree of skill and lengthy period of training required to perform these complex services, the enhanced safety despite increasingly sick patients, improved quality outcomes, and greater clinical value," said ACC President Edward T.A. Fry, MD, FACC, and HRS President Andrew Krahn, MD, FHRS.

By adopting the RUC recommendations for the main ablation services, the RVUs for this family of codes will be 11.2% higher than proposed and 3.7% lower than 2022. Access the ACC's ablation explainer for more details.

While not mentioned in the rule, it's important to note that CMS has amended the Appropriate Use Criteria program to indefinitely delay the penalty phase that was set to begin Jan. 1, 2023.

Staff will provide a more detailed initial breakdown of the rule in the coming days. Look for updated information on and in upcoming issues of The Advocate newsletter. Additional information on the rule can be found in the: Press Release, MPFS Fact Sheet, MSSP fact sheet and QPP Fact Sheets (Note: clicking the link downloads a zip file).

The final 2023 Hospital Outpatient Prospective Payment System (OPPS) rule was also posted today. The CY2023 Hospital Outpatient Prospective Payment System final rule indicates a 3.8% payment update for hospitals based on a projected increase in the hospital market basket of 4.1%, reduced by 0.3% for the productivity adjustment.

ACC staff are reviewing the final rule to identify topics of interest to members and to see how it compares with the topics addressed in previous ACC comments. For more information, access the CMS press release and the CMS fact sheet. An additional CMS fact sheet on Rural Emergency Hospitals can be found here and supplementary addenda and data tables can be found here.

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: ACC Advocacy, Relative Value Scales, Centers for Medicare and Medicaid Services, U.S., Feedback, Outpatients, Fee Schedules, Prospective Payment System, Physicians, Electrophysiology, Hospitals, Policy, Medicare Part B

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