The Centers for Medicare & Medicaid Services (CMS) released the 2023 Medicare Physician Payment Schedule final rule. Notably, CMS adopted the revised CPT guidelines and codes and the AMA/Specialty Society RVS Update Committee (RUC) recommended relative values for additional E/M visit code families, including hospital visits, emergency department visits, home visits and nursing facility visits. These changes allow time or medical decision-making to be used to select the E/M visit level. In total, the E/M code sets being revised for 2023 comprise approximately 20 percent of all allowed charges under the Medicare Physician Payment Schedule. Therefore, these changes are estimated to require a reduction of about 1.6 percent to the 2023 Medicare conversion factor due to statutory budget neutrality requirements.

The CY 2023 Medicare conversion factor (CF) is $33.06, a decrease of $1.55 or 4.5% from the 2022 CF of $34.61. The decrease is largely a result of an expiring 3 percent increase funded by Congress through 2022. The additional approximate 1.6 percent decrease is the result of budget neutrality requirements that stem from the revised E/M changes. The AMA and the Federation are strongly advocating that Congress avert this payment cut, as well as implement an inflationary update for physicians, extend the 5 percent Advanced APM incentive and prevent the steep increase to the participation requirements for APMs, and waive the 4 percent PAYGO sequester.

In response to the Consolidated Appropriations Act, which extended payment for telehealth services to all communities in the country, not just rural areas, and allowed patients to receive telehealth services in their home for 151 days, or five months, after the end of the COVID-19 public health emergency (PHE) ends, CMS finalized its proposal to extend telehealth coverage for the codes that were only going to be on the telehealth list through the end of the PHE for an additional five months.

AMA staff are closely reviewing the final rule and will draft a detailed summary and analysis to share shortly. Please see the following documents for more information: