HRS Responds to the Medicare Physician Fee Schedule Proposed Rule for Calendar Year 2024

The proposed rule, which establishes policies for the following calendar year, focuses on PFS payments as well as policies related to quality reporting and payment adjustment programs.  For CY 2024, the Centers for Medicare & Medicaid Services (CMS) have proposed an almost 3.4% cut to the PFS conversion factor.  HRS vigorously opposed this cut and continues to work with partners to try to stop these continual reductions to Medicare payments to physicians.

As part of the response to the proposed rule, HRS made the following requests regarding billing and payment policies:

• CY 2024 PFS Conversion Factor: In order to mitigate the proposed reductions to the Medicare conversion factor, HRS urged CMS to rescind the proposal to begin paying for a new office and outpatient E/M add-on code (G2211) that is generating a 2% budget neutrality cut to the conversion factor.
• Phrenic Nerve Stimulation System (CPT codes 3X008, 3X009, 3X010, 3X011, 3X012, 3X013, 3X014, 3X015, 9X045, 9X046, 9X047 and 9X048): In response to the evaluation of the values for phrenic nerve stimulation system, HRS urged CMS to finalize the RUC- recommendations for work and direct PE inputs for the family of codes.
• Remote Interrogation Device Evaluation – Cardiovascular (G2066, 93297 and 93298): Out of concern for reimbursement instability created by Medicare contractor pricing, HRS encouraged CMS to finalize the proposal to delete HCPCS code G2066 and accept the RUC-recommended direct PE inputs for CPT codes 93297 and 93298.
• Split (or Shared) E/M Services: Regarding Medicare's discussion of who should bill a facility-based E/M service when both a physician and non-physician practitioner (NPP) contribute to the E/M, HRS urged CMS to permanently modify the policy to allow E/M visits to be selected based on time or medical-decision making (MDM) rather than CMS' previously articulated policy that the billing practitioner should only be the clinician who spent "more than half the total time" delivering the service.
• Request for Comment About Evaluating E/M Services More Regularly and Comprehensively: In response to a general comment request regarding valuation of E/Ms and the general RVU update process, HRS stated that the AMA CPT Editorial Panel and the RUC remain the best-situated entities to provide input to CMS on values, documentation, and coding as a part of the annual PFS rulemaking cycle, including for E/M services.
• Medicare Telehealth Services: As CMS continues to refine its telehealth policies in the wake of the COVID-19 public health emergency-driven proliferation of services provided via telehealth, HRS commended the agency on its attempts to increase patient access to care via telehealth, and also encouraged CMS to establish distinct policies for those services that are furnished via Category I telehealth (i.e., it is an otherwise face-to-face furnished service that happens to be delivered via telehealth) versus virtual services, which are inherently remotely delivered in their description and character, in order to ensure HRS members have clear billing and documentation guidance.
• Appropriate Use Criteria for Advanced Diagnostic Imaging Program: In response to CMS acknowledgment of difficulties surrounding the Appropriate Use Criteria (AUC) for Diagnostic Imaging Program, which would have required clinicians ordering advanced diagnostic imaging services to consult AUC via a clinical decision support tool and communicate those results to the furnishing clinician for payment purposes (and potentially subject certain physicians to prior authorization requirements), HRS strongly supported CMS' proposal to pause implementation of the program and to rescind the current AUC program regulations.

As mentioned above, the proposed rule is also the vehicle for CMS to make changes to its quality reporting and value-based payment policies under the Quality Payment Program (QPP). HRS provided the following input on the agency's QPP policies:

• Merit-Based Incentive Payment System (MIPS) Performance Threshold: In response to CMS' proposal to ramp up the reporting requirements and the total number of points needed to avoid a payment cut under MIPS (i.e., the MIPS "performance threshold"), HRS strongly opposed the proposed increase to the MIPS performance threshold.
• Advancing Care for Heart Disease MIPS Value Pathway (MVP): As CMS tries to simplify MIPS reporting requirements and offer specialty-specific reporting options, HRS supported the CMS proposal to add the following measures to the Advancing Care for Heart Disease MVP:
  • Q006: Coronary Artery Disease (CAD): Antiplatelet Therapy
  • Q118: Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker–(ARB)–Therapy - Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%)
  • Q487: Screening for Social Drivers of Health
• Specialist Participation in Advanced APMs: As policymakers continue attempts to move physicians into value-based reimbursement models, HRS expressed concern about the policies proposed, and their impact on the ability of electrophysiologists to move toward alternative payment models (APMs).

The PFS final rule for CY 2024 will be published on or around November 1st and implemented January 1, 2024.