On July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) published the annual Medicare Physician Fee Schedule proposed rule. The rule describes proposed payment and policy changes for 2023, including several proposals which impact physiatry. On September 6, your Academy submitted comments to the proposed rule, encouraging CMS to revise several proposals. Additionally, AAPM&R has joined a broad coalition to show support for bi-partisan legislation, H.R. 8800, the Supporting Medicare Providers Act of 2022, which provides a 4.42% positive adjustment to the MPFS for 2023.
Updates to Physician Payment
Of immediate concern, the rule includes a reduction to the Conversion Factor from $34.6062 to $33.0775, a 4.42 percent reduction. View this payment comparison chart to determine impact of this proposed reduction on specific PM&R codes. This is primarily due to the expiration of a one-year 3 percent increase in payments, approved by Congress at the end of last year. The additional 1.42 percent cut is due to updates to several Evaluation and Management (E/M) code families, including inpatient hospital visits and nursing facility visits. Increases to codes in these E/M code families must be offset by a reduction in the conversion factor. AAPM&R continues to express concerns to Congress and CMS about the annual threat of cuts to physician payment and the lack of increases to payment commensurate with inflation and increased costs of running a medical practice and this issue was emphasized during our recent Hill Day. This will continue to be an advocacy priority for AAPM&R and organized medicine for the remainder of the year and beyond.
Additional Proposed Policy Changes
A comprehensive fact sheet about the rule is available on the CMS website. If you have specific questions about the proposed rule, please email healthpolicy@aapmr.org.
Updated December 2021
Following the November 2, 2021 publication of the annual Medicare Physician Fee Schedule final rule by the Centers for Medicare & Medicaid Services (CMS), several updates have been made impacting the Conversion Factor. On December 10, legislation was signed averting an almost 10% cut to the fee schedule, which was scheduled to take effect January 1. AAPM&R advocated against these cuts throughout 2021, culminating in a grassroots advocacy campaign this November, during which 208 members sent a total of 635 messages to their Congressional Leaders. As a result, rather than a 10% cut, the fee schedule will see a 0.83% cut to payment. As of late December, CMS has finalized a 2022 Conversion Factor of $34.6062, decreased from the 2021 Conversion Factor of $34.8931.
Click here for a chart of final RVUs and payment rates for physiatry services effective January 1, 2022 reflective of the updated $34.6062 Conversion Factor.
While the December 10 legislation is a huge win for physiatry and the entire house of medicine, the changes to physician payment in the bill are only a temporary solution, as they expire at the end of 2022. We anticipate we will be advocating early and throughout 2022 to urge Congress to identify a permanent solution to the payment cuts physicians have been facing each year in recent history.
The rule finalizes payment and policy changes which will take effect January 1, 2022. Earlier this year, your Academy submitted detailed comments to CMS regarding the proposed rule. The rule also finalizes policy on several issues your Academy has been monitoring including:
A comprehensive fact sheet is now available on the CMS website.
The complete rule is available on the Federal Register website.
A detailed CMS fact sheet is available on the Medicare website.
Medicare payment for physicians, and some non-physician practitioners (NPPs), is based on set rates under Medicare Part B. The system for payment, known as the Medicare Physician Fee Schedule (MPFS), is used when paying for: professional services of physicians and some NPPs; covered services incident to physicians’ services (other than certain drugs covered as incident to services); diagnostic tests (other than clinical laboratory tests); and radiology services. The MPFS also addresses various quality issues, fraud and abuse issues, and other issues that impact physicians. CMS updates the MPFS regulations annually, with comment periods open prior to implementation of the final rule.
If not, email us at healthpolicy@aapmr.org.