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What you need to know about the 2023 CMS Physician Fee Schedule 

Get ready for the 2023 CMS Physician Fee Schedule to get properly paid and optimize collections. Read a review of this final rule to understand the major updates and policy changes for the new year.

The Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates and policy changes for Medicare payments under the 2023 Physician Fee Schedule (PFS) and other Medicare Part B issues. This rule went effective on January 1 and was implemented on January 3.   

To get properly paid for your rendered services, your billing staff must be aware of these CY 2023 MPFS updates. The final rule includes telehealth services, expanded coverage for colorectal cancer screening, audiology services, and other covered services.   

Here is a review of what you need to know about the 2023 CMS Physician Fee Schedule   

CY 2023 MPFS Telehealth Services  

  • There are newly added HCPCS codes in the list of Medicare telehealth services on a Category 1 basis. These codes are: G0316, G0317, G0318, G3002, and G3003.  
  • Many services that are temporarily available as telehealth services are still available for the duration of the COVID-19 Public Health Emergency (PHE) on a Category 3 basis. These include CPT codes 90875, 90901, 92012, 92014, 92550, 92552, 92553, and more.   
  • The CMS implemented the 151-day extensions of Medicare telehealth flexibilities in the CAA, 2022. This includes allowing telehealth services to be provided in any geographic area and any originating site setting, including the patient’s home, and allowing certain services to be provided via audio-only telehealth.   
  • For 2023, medical practices should continue billing telehealth claims with the place of service indicator they bill for an in-person visit. They must use modifier 95 to identify them as telehealth services through CY 2023 or the end of the year the PHE ends.   
  • The payment amount for HCPCS code Q3014 (Telehealth originating site facility fee) is 80% of the lesser of the actual charge or $28.64 for CY 2023 services.   

Evaluation and Management (E/M) Visits  

  • Regarding Coding, the CMS adopted revised CPT codes for Other E/M visits (except for prolonged services). This includes revised CPT E/M guidelines for medical decision-making (MDM) levels,se of history and exam to decide visit level, new descriptor times (where relevant), and more.   
  • The CMS also finalized Medicare-specific coding for prolonged Other E/M services and created three new G codes (one per E/M family). These are G0316, G0317 and G0318.   
  • For Split (or Shared) Visits, the CMS delayed the CY 2022 final policy for another year, defining the substantive portion of a split or shared visit as more than half of the total practitioner time. The substantive portion can be 1 of the following: history, physical exam, MDM, or more than half of the total practitioner time.   
  • Regarding Critical Care, the 2023 CMS Physician Fee Schedule added a technical correction clarifying that the reporting threshold time for the add-on code for critical care services is the same for split (or shared) critical care as for critical care that isn’t split (or shared). Providers must use CPT code 99292 to report additional, complete 30-minute increments provided to the same patient; therefore it isn´t reported until at least 104 minutes are spent.   

Expansion of Coverage for Colorectal Cancer (CRC) Screening and Reducing Barriers   

  • Modification of coverage and payment requirements for specific CRC screening tests to start when the individual is 45 years of age or older. These tests include Blood-based Biomarker Tests, Immunoassay-based Fecal Occult Blood Test (iFOBT), Barium Enema Test, and more. Screening Colonoscopy continues with no minimum age limit.    
  • Expansion of the regulatory definition of CRC screening tests. The CMS did this to include a follow-on screening colonoscopy after a Medicare-covered non-invasive stool-based CRC screening test returns a positive result.   

CY 2023 MPFS Audiology Services  

  • Finalization of a policy to allow patients direct access to an audiologist for specific diagnostic tests for non-acute hearing conditions without an order from a treating physician or some nonphysician practitioners (NPP). This policy requires using the new AB modifier instead of the HCPCS code GAUDX.   
  • Services billed with modifier AB, with any of the codes included in HCPCS GAUDX, would consist of those the audiologist personally provides on a single treatment day to allow patients to get care for non-acute hearing assessments. It also includes the services related to implanted auditory prosthetic devices unrelated to disequilibrium, hearing aids, or examinations to prescribe, fit, or change hearing aids.   
  • Read the full permissible use of the AB modifier here.  

Behavioral Health  

  • Creation of a new HCPCS code (G0323) describing General Behavioral Health Integration performed by clinical psychologists (CP) or clinical social workers (CSW). This code will help account for monthly care integration where the mental health services provided by a CP or CSW serve as the focal point of care integration.   

Chronic Pain Management  

  • Creation of two new G codes (G3002 and G3003) performed by physicians and other qualified health professionals, describing monthly CPM for payment.   

The final rule also includes updates and policy changes regarding opioid treatment programs (OTPs), dental and oral health services, skin substitute products. and more.

Learn more about the 2023 CMS Physician Fee Schedule and how to optimize your revenue collection this new year. Feel free to reach us at sales@hpiinc.com. Our team will set up a meeting to discuss how Health Prime can maximize your revenue.

Subscribe to our Health Prime blog. Stay tuned to all the latest updates learn how to improve your medical practice, and ensure you are getting paid for your work. 

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