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MGMA's Final 2023 Physician Fee Schedule Analysis

11/22/2022 3:51 PM | Rebekah Francis (Administrator)

Your guide to 2023 Medicare payment rules

The Centers for Medicare & Medicaid Services released its final 2023 Physician Fee Schedule (PFS) rule, which includes payment and coding updates for Medicare services, modifications to telehealth, and changes to the Quality Payment Program.

MGMA Government Affairs reviewed, analyzed, and distilled over 2,000 pages of the final rule to draft this member-benefit analysis. The resource breaks down significant payment and quality reporting changes for 2023 and offers practical takeaways for busy medical group practice executives. Key regulatory provisions include:

  • Setting the CY 2023 PFS conversion factor at $33.0607 (a reduction of 4.47%) and the CY 2023 national average anesthesia conversion factor at $20.6097. MGMA is advocating for a legislative fix to address the reimbursement cuts resulting from the lower conversion factor;
  • Delaying the split/shared E/M billing policy until CY 2024, permitting the billing clinician to bill for services based on history, exam, medical decision marking or time in 2023;
  • Continuing payment for Medicare telehealth services that are temporarily included on the telehealth list for 151 days following the conclusion of the COVID-19 public health emergency and maintains payment parity between in-person and telehealth visits through 2023;
  • Permitting auxiliary personnel to furnish behavioral health services incident to a physician or NPPs services under general instead of direct supervision;
  • Increasing Qualifying APM Participant (QP) and partial QP threshold in performance year 2023; and
  • Finalizing 5 new MIPS Value Pathways (MVPs), for a total of 12 MVPs available for voluntary reporting in 2023.

Interested in learning more about the updates to Medicare physician payment and quality reporting that will be in effect come Jan. 1, 2023? Join MGMA Government Affairs on Dec. 13 at 1 p.m. ET for our member-exclusive 2023 Medicare Outlook webinar to gain insights about payment and policy changes outlined in the final 2023 PFS rule. Register here.


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