2024 CMS Physician Fee Schedule: Key Changes for Healthcare Providers

November 09, 2023 By: Quadax

CY 2024 CMS payment guidelines, plus an extended telehealth reimbursement waiver

On November 2, CMS released the Medicare Physician Fee Schedule (PFS) final rule for calendar year (CY) 2024, finalizing a 1.25 percent overall reduction for physician services next year. The physician fee schedule conversion factor for 2024 is $32.74, a $1.15 (3.4%) decrease from the 2023 conversion factor of $33.89.

Physician groups were swift to express their strong opposition to the payment cuts imposed by CMS on doctors. Trade associations representing physicians have actively fought against the conversion factor cut since its initial proposition by CMS in July. The American Medical Association (AMA), the American Hospital Association, and the Medical Group Management Association (MGMA), among other associations, have labeled the proposed PSF payment cut as detrimental to physician practices and financially unsustainable.

CMS Administrator Chiquita Brooks-LaSure said in a statement, "CMS remains steadfast in our commitment to supporting physicians and ensuring that people with Medicare have access to the care they need to stay healthy as well as navigate health conditions they are facing."

Brooks-LaSure also emphasized the positive impact of additional payment policies outlined in the rule, which will not only enhance rates for primary care but also ensure better accessibility to mental healthcare services. Furthermore, Medicare will introduce payment coverage for innovative navigation services aimed at assisting Medicare beneficiaries with critical illnesses, such as cancer.

Under the new reimbursement rules, Medicare will now provide payment for the training of caregivers in implementing treatment plans for patients with specific diseases or illnesses like dementia. These services will be covered under the PFS and can be provided by physicians or non-physician practitioners such as nurse practitioners, clinical nurse specialists, certified nurse-midwives, physician assistants, clinical psychologists, physical therapists, occupational therapists, or speech-language pathologists. These training services will be an integral part of individualized treatment plans or therapy care plans. 

Also effective Jan 1, CMS is in the final stages of implementing an additional payment feature for HCPCS code G2211 in the healthcare common procedure coding system. This add-on code aims to provide a more accurate reflection of the resource costs associated with evaluation and management visits for primary care and longitudinal care. It will primarily apply to visits in outpatient settings and offices, providing additional payment to acknowledge the significant expenses incurred when clinicians serve as the ongoing central figure for all required services or are involved in the continuous care of patients with a single, severe condition or a complex condition.

In addition, Medicare has extended an important reimbursement provision for health systems that utilize telehealth services until the conclusion of 2024. This extension also includes a safeguard for physicians who work remotely, ensuring their privacy and security. CMS recognized the concern surrounding practitioners who offer telehealth services from their homes and the requirement to disclose their home address on enrollment and claims forms. To address this issue, the agency has decided to postpone this provision until January 1, 2025. As a result, distant site practitioners will still be able to use their registered practice location instead of their home address when delivering telehealth services from the comfort of their homes. This decision ensures privacy and security for physicians working remotely.

Furthermore, as part of their efforts to improve healthcare transparency, CMS has implemented several changes in the regulation regarding price transparency for hospitals. These changes mandate that hospitals must now make their cost data publicly accessible in a more standardized manner, with the aim of facilitating easier utilization of the data by third-party developers and simplifying the process for patients to understand and interpret the information. While the data was already required to be made available, concerns had been raised regarding the usability of the provided information.

"The final rule strengthens hospital price transparency by improving the standardization of hospital standard charges and enhancing CMS’ enforcement capabilities, thereby better enabling the American people to understand and meaningfully use hospital standard charges for items and services," Brooks-LaSure said in a press release.

The finalized proposal also makes changes to the data reporting and payment requirements for clinical diagnostic laboratory tests (CDLTs), including revisions to the terminology of the “data collection period” and “data reporting period,” as well as a new requirement for data collection every three years. There will also be a gradual implementation of payment reductions to align with the amendments made in Section 4114(a) of the Consolidated Appropriations Act (2023). For the year 2023, the payment for a CDLT that is not an advanced diagnostic laboratory test will remain unchanged compared to the payment amount set in the previous year. Furthermore, from the years 2024 to 2026, the payment for these tests cannot be reduced by more than 15 percent compared to the amount established in the preceding year.

Read about all of these finalized policy changes taking effect on Jan 1, 2024 in more detail on this CMS fact sheet. 

Quadax is committed to staying on top of payer changes. Our comprehensive, up-to-date library of claim processing rules and edits are updated bi-weekly by our Edits & Documentation Group (EDG). The Quadax EDG team of experts, who are knowledgeable in both billing and ANSI claim requirements, reference nationally recognized sources, including AMA, CPT guidelines, Medicare PFS, and more. 

Need help navigating the payer landscape to maximize your reimbursement? Schedule a strategy call and let’s take on the revenue cycle together!


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