2024 MEDICARE PHYSICIAN FEE SCHEDULE (MPFS)
FINAL RULE RELEASED
Includes 2024 Quality Payment Program Proposals
Final 2024 Conversion Factor: $32.7442
This afternoon, CMS released the CY 2024 MPFS Final Rule, along with a press release, a physician fee schedule fact sheet, and a shared savings program fact sheet.
2024 MPFS Conversion Factor[1]
The final rule announced a CY 2024 MPFS conversion factor of $32.7442 a decrease of approximately 3.4% ($1.15) from the CY 2023 MPFS conversion factor of $33.89. The CY 2024 MPFS conversion factor reflects the following:
- the 0.00% update adjustment factor as established in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA);
- and a 1.25% update provided under the Consolidated Appropriations Act, 2023 (CAA, 2023);
- a budget neutrality adjustment of -2.18%, primarily due to the implementation of the revised complex care add-on code (G2211).
According to the CMS estimated impact on total allowed charges by specialty (Table 118), ophthalmology will see an overall reduction of -1%. For CY 2024, the proposed Medicare payment rate for 66984 is $528.49, a decrease of $13.37 from the CY 2023 Medicare payment of $541.86. Remaining payment rates for additional ophthalmic services can be calculated using the proposed relative values in Addendum B.
We will continue to advocate with the medical and surgical community to prevent these Medicare physician payment cuts from being implemented on January 1, 2024.
“Complexity” Add-on Code Finalized- Effective January 1, 2024
In the CY 2021 MPFS, CMS finalized a “complexity” add-on code, HCPCS G2211, that physicians could bill separately in addition to office and outpatient Evaluation and Management (E/M) codes (CPT 99202 – 99215). While CMS intended the new add-on code to address the additional time, intensity, and practice expense associated with ongoing care, including for a single serious or complex condition, its implementation would have resulted in a redistribution of approximately $3 billion dollars across the MPFS. Coupled with the significant increases in office and outpatient E/M services and other payment and policy changes implemented in CY 2021, physicians faced a 10.2% reduction in the conversion factor. To mitigate the financial impact, Congress delayed implementation of the complexity add-on through CY 2024.
In this final rule, CMS explains that the moratorium on Medicare payment under the PFS for HCPCS code G2211 will end on December 31, 2023, and the agency will make HCPCS code G2211 separately payable effective January 1, 2024. CMS finalized refinements to the complex care add-on code policy, including a change in the utilization assumptions, that collectively reduces the redistributive impact to the CY 2024 CF by nearly one third of the estimated impact described in the CY 2021 Medicare PFS final rule.
Discarded Drug Amounts
As a reminder, in the CY 2023 Medicare PFS, CMS implemented section 90004 of the Infrastructure Investment and Jobs Act, which requires manufacturers to provide a refund to CMS for discarded amounts from certain single-dose container or single-use package drugs. To assist with this policy, Medicare providers who administer Part B drugs must append the JZ modifier to indicate there were no discarded amounts. As a reminder, since 2017, providers have been required to report the JW modifier on their Part B drug claims to indicate discarded amounts, and that will continue.
In this rule, CMS finalized a modification to the JW and JZ modifier policy. Specifically, CMS will require that drugs separately payable under Part B from single-dose containers that are furnished by a supplier who is not administering the drug be billed with the JZ modifier.
Medicare Telehealth Services
For CY 2024, CMS finalized refinements to the process for considering changes to the Medicare Telehealth Services List, now that the COVID-19 Public Health Emergency (PHE) has ended. Specifically, CMS said it will “classify and consider additions to the Medicare Telehealth Services List as either permanent, or provisional” to avoid potential continuing confusion among those who submit requests to add services to the Medicare Telehealth Services List, and as the agency considers the expiration of the Medicare telehealth flexibilities extended by the CAA, 2023 through the end of CY 2024.
Quality Payment Program
MIPS Value Pathways (MVPs)
CMS has finalized 5 new MVPs and consolidated 2 previously established. None of the available MVPs are relevant to ophthalmology. As a reminder, the addition of MVPs is part of a greater effort at CMS to sunset traditional MIPS after the end of the 2027 performance period/2029 payment year. CMS did not finalize the timeframe in which MVP reporting would no longer be voluntary and said any proposal to sunset traditional MIPS will be made in future rulemaking. ASCRS maintains that the traditional MIPS pathway should continue to be an option.
Performance Threshold Proposals
The threshold to avoid a MIPS penalty will remain at 75 points for performance year 2024. This is a huge win from our advocacy efforts as CMS originally proposed an 82-point threshold to avoid a penalty.
Performance Category Weights
For the 2024 performance year/2026 payment year, CMS will maintain the following performance category weights:
- 30% for the Quality performance category.
- 30% for the Cost performance category.
- 15% for the Improvement Activities performance category.
- 25% for the Promoting Interoperability performance category.
Additional Details to Come
ASCRS is reviewing the 2,709-page rule and additional information will be detailed in upcoming editions of Washington Watch Weekly.
[1] ASCRS observed a discrepancy in the conversion factor, including the budget neutrality adjustment, across CMS’ press release, fact sheet and final rule preamble language (p. 1948 of the display version of the CY 2024 MPFS). ASCRS clarified the final figures with CMS staff and have used those figures in this communication.