Five Things for ASC Leaders to Consider with the 2023 CMS Final Rule
- The CMS 2023 Medicare Physician Fee Schedule (PFS) Final Rule includes payment rate and procedures updates for physicians’ services paid under this payment schedule.
- The CMS Final Rule will go effective on January 1, 2023.
- For ASCs, these changes include increased pay rate for iTind procedures, expanded colorectal cancer screening tests coverage, added new procedures, and more.
On November 01, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates and policy changes for Medicare payments under the Physician Fee Schedule (PFS). This includes Medicare Part B issues, effective on or after January 1, 2023.
According to the CMS Final Rule fact sheet, the Calendar Year (CY) 2023 PFS final rule is one of several rules that reflect a broader Administration-wide strategy. The strategy aims to create a more equitable healthcare system that improves accessibility, quality, affordability, and innovation.
Physicians’ services paid under the PFS are furnished in various settings, including physician offices, hospitals, ambulatory surgical centers (ASCs), skilled nursing facilities, other post-acute care settings, and more.
For ASCs leaders, here are some aspects of this 2023 CMS final rule they should know:
1. Increased pay rate for iTind procedures
CMS will increase the pay rate for iTind procedures in ASCs and hospital outpatient departments (HOPDs). The organization finalized an average pay rate of $7,274.78 in ASCs and $8,221.74 per procedure in HOPDs.
2. Expansion of colorectal cancer screening tests coverage
The 2023 PFS final rule expands Medicare coverage for specific colorectal cancer screening tests. This added up is achieved by reducing the minimum age payment and coverage limitation from 50 to 45.
CMS also expanded the regulatory definition of colorectal cancer screening tests to include colorectal cancer screening when a follow-up colonoscopy screening after a Medicare-covered noninvasive stool-based colorectal cancer screening test comes back positive.
3. ASC’s new procedures added
CMS added four new procedures to the covered ASC procedures. The procedures are:
- 19307: mast mod rad.
- 37193: rem endovas vena cava filter.
- 38531: open bx/exc inguinofem nodes.
- 43774: lap rmvl gastr adj all parts.
4. Physician pay conversion factor reduction
Medicare’s PFS final rule will reduce the physician pay conversion factor by 4.48 percent to $33.06. The conversion factor used to calculate physician reimbursement will decline by $1.55 in 2023.
5. Updated ASC payment system rate
CMS finalized the productivity-adjusted hospital market basket update to the ASC payment system rate. This update means an ASC payment system rate of 3.8 percent applied to ASCs meeting relevant quality reporting requirements.
Read the Calendar Year (CY) 2023 Physician Fee Schedule final rule fact sheet here.