2024 MEDICARE PHYSICIAN FEE SCHEDULE (MPFS)
PROPOSED RULE RELEASED
Includes 2024 Quality Payment Program Proposals
Proposed 2024 Conversion Factor: $32.7476
This afternoon, CMS released the CY 2024 MPFS Proposed Rule. CMS also released a press release, a physician fee schedule fact sheet, and a shared savings program fact sheet. ASCRS will be submitting comments.
2024 MPFS Conversion Factor
The CY 2024 proposed MPFS conversion factor is $32.7476, a decrease of approximately 3.4% ($1.1396) from the CY 2023 MPFS conversion factor (CF) of $33.8872. The CY 2024 proposed 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),
- a budget neutrality adjustment of -2.17%, primarily due to the implementation of the revised complex care add-on code (G2211),
- and a 1.25% update provided under the Consolidated Appropriations Act, 2023 (CAA, 2023).
According to the CMS estimated impact on total allowed charges by specialty (Table 104), ophthalmology will see an overall reduction of -1%. For CY 2024, the proposed Medicare payment rate for 66984 is $528.22, a decrease of $13.64 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.
As a reminder, the CAA, 2023 provided a 2.5% update for CY 2023 and a 1.25% update for CY 2024. These amounts do not reflect the lower update amount for CY 2024; effectively, an additional loss of 1.25%.
We will continue to advocate with the medical and surgical community to prevent these Medicare physician payment cuts.
“Complexity” Add-on Code
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, it’s implementation would have resulted in a redistribution of approximately $3 billion 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 at least CY 2024.
In this proposed 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 proposes to make HCPCS code G2211 separately payable effective January 1, 2024, with some limitations. Importantly, CMS is also proposing 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, effective July 1, 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.
Now, CMS is proposing additional policies to implement the aforementioned provision, including a modification to the JW and JZ modifier policy. According to CMS, beginning October 1, 2023, CMS will begin editing for correct use of both the JW and JZ modifiers for billing and payment codes for drugs from single-dose containers. Specifically, CMS proposes to 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 is proposing clarifications and revisions to the process for considering changes to the Medicare Telehealth Services List, now that the COVID-19 Public Health Emergency (PHE) has ended. CMS believes this is important 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. Of note, CMS is proposing to restore the simple binary that existed with Category 1 and 2, without displacing or disregarding the flexibility of Category 3. Essentially, CMS wishes to simply classify and consider additions to the Medicare Telehealth Services List as either permanent or provisional.
Quality Payment Program
MIPS Value Pathways (MVPs)
CMS proposed 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
CMS is proposing to raise the threshold to avoid a penalty to 82 points. This significant increase from 75 points in 2023 is because CMS is proposing to use the mean final score from the 2017–2019 performance years (2019–2021 payment years), which would result in a performance threshold of 82 points.
Performance Category Weights
For the 2024 performance year/2026 payment year, the performance category weights are the following:
- 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.
A fact sheet is available on the CY 2024 Quality Payment Program proposed changes.
Additional Details to Come
ASCRS is reviewing the 1,920-page proposed rule, and additional information will be detailed in upcoming editions of Washington Watch Weekly.
