CMS Finalizes CY 2023 Physician Fee Schedule Rule - McDermott+Consulting

CMS Finalizes CY 2023 Physician Fee Schedule Rule

On November 1, 2022, the Centers for Medicare & Medicaid Services (CMS) released the CY 2023 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B [CMS-1770] Final Rule, which includes final policies related to Medicare physician payment and the Quality Payment Program (QPP). The final rule includes other significant changes, including changes related to accountable care organizations (ACOs), the launch of the Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs), telehealth services, initiatives promoting access to behavioral health services, and other changes to further develop physician quality initiatives.

The CY 2023 PFS final rule highlights continued problems with physician payment, and great uncertainty remains about final Medicare reimbursement rates. Stakeholders are turning to Congress to seek relief, and some congressional action on these issues is likely by the end of the year. Lawmakers’ appetite to continuously patch physician payments is also unclear. While stakeholders are urging Congress to address cuts in 2023, there are also calls for Congress to find a more permanent solution to avoid the annual patches to the PFS.

Key Takeaways from the CY 2023 PFS Final Rule

  • Finalizes a 2023 physician CF of $33.0607, representing a 4.47% reduction from the 2022 CF of $34.6062
  • Implements the statutory extension of coverage for certain telehealth services to 151 days after the end of the public health emergency (PHE)
  • Begins the new MVPs as a voluntary alternative to MIPS in 2023 with 12 different pathways
  • Finalizes changes to the Medicare Shared Savings Program (MSSP) and introduces new advance investment payments intended to achieve the Administration’s goal of 100% participation in accountable care relationships by 2030
  • Outlines policies to make behavioral health care easier to access, including addressing the shortage of behavioral health practitioners

Read on for a topline summary of the major provisions in the final rule.

  • The final regulation text is available here.
  • The press release is available here.
  • The fact sheet on payment policies is available here.
  • The MSSP factsheet is available here.
  • CMS also issued a blog post on the finalized behavioral health changes.

Click here to download the detailed summary of the key provisions in the final rule.