How will the CMS Fee Schedule Affect You?

Each year, the Centers for Medicare & Medicaid Services (CMS) issues regulations that impact the reimbursement of physicians. On November 2, 2023, CMS issued a final rule updating payment policies and rates for physicians paid under the Medicare Physician Fee Schedule in 2024. The final rule illustrates the importance of the AAN’s regulatory advocacy efforts on behalf of neurologists and their patients. Read the AAN's summary of the final rule. The AAN previously submitted 48 pages of detailed comments in response to the various proposals made by CMS. 

CMS is projecting that the overall impact of changes contained in the rule will result in a one-percent increase in payments to neurology as a specialty broadly. Due to the phase-out of temporary relief measures contained in the Consolidated Appropriations Act of 2023 and statutory budget neutrality requirements, CMS finalized a reduction in the Fee Schedule conversion factor of approximately 3.4 percent to 32.74. The AAN will continue to work with legislators to offset the impacts of statutorily required cuts. The AAN is committed to payment reform efforts to promote a sustainable payment system, such as ensuring physicians receive an inflationary adjustment tied to the Medical Economic Index, and to working with regulators and legislators to ensure that CMS appropriately values the work done by neurologists.

The final rule implements a number of critical changes impacting evaluation and management (E/M) services, including implementation of an add-on code, G2211, to account for the complexity associated with serving as the focal point of care for a patient with a complex condition and changes to the definition of “substantive portion” as it relates to billing for split (or shared) visits so that the billing practitioner can be identified based on either the majority of total time or a substantive part of the medical decision making as defined by CPT.

CMS is also implementing a number of key changes impacting telehealth services. These include implementing key provisions of the Consolidated Appropriations Act (CAA) of 2023 that extend certain flexibilities in place during the COVID-19 Public Health Emergency (PHE) through December 31, 2024. These key flexibilities include allowing telehealth services to be furnished in any geographic area and in any originating site setting, including the beneficiary’s home, allowing certain services to be furnished via audio-only communication technology, and continued coverage of services temporarily added to the Medicare Telehealth list through December 31, 2024. CMS is also finalizing policy to pay for telehealth services furnished to beneficiaries in their homes at the non-facility rate and is extending a number of flexibilities associated with supervision of APPs and residents through 2024.

In alignment with advocacy, CMS is also implementing a number of new codes associated with addressing health related social needs including codes for:

• Care Giver Training Services
• Community Health Integration Services
• Social Determinants of Health Assessment Services
• Principal Illness Navigation Services

In a significant win for AAN advocacy, CMS is rescinding the Appropriate Use Criteria program and all implementing regulations to allow for reevaluation. CMS states that in doing this, in alignment with the AAN’s long-standing advocacy on this topic, the goals of appropriate, evidence-based, coordinated care can be achieved more effectively, efficiently, and comprehensively through other CMS quality initiatives.

As the agency does every year, CMS is making modifications to the Quality Payment Program. CMS finalized minor modifications to the Merit-based Incentive Payment System (MIPS) and is notably maintaining the MIPS performance threshold at 75 points, in alignment with the AAN’s comments. CMS is not implementing additional neurology-related MIPS Value Pathways (MVPs) for 2024, as there are already 3 neurology-related MVPs that have been previously implemented.

Every year, the AAN hosts a free member webinar that features upcoming changes and updates to the Medicare Physician Fee Schedule. Sign up to receive registration information.