NASS Insider


November 22, 2022


CMS Publishes Final Rules for 2023 Medicare Payments to Physicians and Outpatient Departments/ASCs


The Centers for Medicare and Medicaid Services (CMS) recently released the final rules for 2023 Medicare payments to physicians and hospital outpatient departments/ambulatory surgical centers (ASCs). Several significant changes have been finalized and summarized below; additional details are available at www.spine.org/finalrule. Both final rules will be implemented January 1, 2023.

Physician Fee Schedule Rule
  • Conversion Factor. A significant proposed policy change is a 4.47% reduction (to $33.0607) in the 2023 Medicare conversion factor due to budget neutrality and other statutorily-mandated requirements. NASS Advocacy is continuing outreach to Congress to request that they take the necessary steps to ensure that changes in underlying payment policies do not counteract efforts to protect our health care system and ensure patient access to care by enacting the proposed conversion factor cut.
  • Telehealth. CMS finalized its proposal to extend coverage for certain telehealth services for 151 days past the end of the current COVID public health emergency (PHE). This waiver allows for flexibility regarding the location where telehealth services are provided, what technology can be used, and how the services are paid.
  • Quality Payment Program (QPP). CMS finalized its proposal to implement the MIPS Value Pathways (MVP) beginning in 2023 on a voluntary basis. While CMS has indicated they would like all providers to be in an MVP by 2027, they have not finalized a proposal on this timeline. The final rule includes five new MVPs and refinements to seven existing MVPs.
  • Refinement of Relative Work Values (RVUs). In the proposed rule, CMS had rejected the RUC recommended work RVUs for several spine codes. NASS strongly opposed these reductions in value both in writing and via meetings with CMS, during which it was argued that the RUC uses a sound and proven methodology to value codes. NASS raised significant concerns about CMS using seemingly random crosswalk codes to develop values, noting that it is not an approved methodology. NASS was successful in persuading CMS to increase their proposed work RVUs for several of the codes to the RUC-recommended values.
OPPS/ASC Rule

CMS is increasing the hospital outpatient conversion factor by 1.67% and the ASC conversion factor by 3.88% for 2023. Other changes include:
  • Inpatient Only List. CMS finalized its proposal to remove CPT code 22632 from the inpatient only list (IOL), a change that NASS supported. CMS also added code 22860 to the IOL, allowing it to be billed only in the inpatient hospital setting.
  • Prior Authorization. CMS finalized the addition of a new service category, facet joint interventions, requiring prior authorization when provided in the hospital outpatient setting, due to concerns about increased utilization of the procedures recently. NASS submitted extensive comments in opposition to this proposed policy change in response to the proposed rule. Unfortunately, CMS is proceeding with finalizing this change, while slightly delaying its implementation until July 1, 2023. The new policy will require codes 64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, and 64636 to go through the prior authorization process before being performed in the hospital outpatient setting.
Link