CMS Releases Proposed 2024 Medicare Physician Fee Schedule and Hospital OPPS Rule

The Centers for Medicare and Medicaid Services (CMS) has released the 2024 Medicare Physician Fee Schedule (PFS) proposed rule. Of note, the PFS conversion factor has been reduced by roughly 3.4% from $33.8872 to $32.7476, and the overall reimbursement for cardiovascular services is projected to remain flat compared with 2023, with changes to policies and individual services roughly balancing out. Individuals and groups will see different impacts depending on patient populations and services offered.

Initial highlights from the proposed rule include:

  • A proposal to pause the Appropriate Use Criteria (AUC) Mandate Program for reevaluation, citing difficulties reasonably operationalizing the program.
  • A proposal to further delay implementation of the split/shared billing changes, allowing history, exam, medical decision making or time to determine who bills the visit. CMS proposes to postpone implementation through at least Dec. 31, 2024.
  • A proposal to establish new rules for expanding supervision of cardiac rehabilitation to nonphysician practitioners.
  • Updated code values for new/revised services, cyclical updates to the Quality Payment Program, updates to the MIPS Value Pathways (MVPs) for 2024 and other payment policy proposals.

The 2024 Hospital Outpatient Prospective Payment (OPPS) and Ambulatory Surgical Center (ASC) Payment Systems proposed rule was also issued today. CMS proposes a 2.8% increase to OPPS payment rates that reflects a market basket update of 3.0% reduced by a productivity adjustment of 0.2%. At this point, it appears there are no proposed changes to allow cardiac ablation in the ASC setting.

Additional information on the rule can be found in the Medicare PFS Press Release, Medicare PFS Fact Sheet, Medicare Shared Savings Program Fact Sheet, and QPP Fact Sheet. The OPPS Press Release, OPPS Fact Sheet, and a separate fact sheet on Hospital Price Transparency are also available. ACC Advocacy staff will provide a more detailed breakdown of the proposed rules in the coming days. Look for updated information on and in upcoming issues of The Advocate newsletter.

Keywords: ACC Advocacy, United States, Centers for Medicare and Medicaid Services, U.S., Medicare, Area Under Curve, Medicaid, Outpatients, Fee Schedules, Physicians, Policy, Decision Making

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