What Labs Need to Know About the 2023 Medicare Physician Fee Schedule
A brief look at some of the proposed changes that will affect clinical labs
The Centers for Medicare & Medicaid Services (CMS) recently published its proposed rule for the Calendar Year (CY) 2023 Medicare Physician Fee Schedule (PFS), looking for public comment on the changes. According to the CMS release, the changes proposed in the 2023 PFS aim to help create “a more equitable health care system.” Here’s a quick look at the key changes most likely to affect clinical laboratories.
A couple of the key proposals relate to Protecting Access to Medicare Act of 2014 (PAMA) requirements, specifically those involving price data reporting timelines and scheduled PAMA price cuts. The 2023 PFS clarifies that, due to delays in those scheduled cuts, the “data collection period” is January 1, 2019, through June 30, 2019, for the “data reporting period” of January 1, 2023, through March 31, 2023. Another proposed revision states that “initially, data reporting begins January 1, 2017, and is required every [three] years beginning January 2023.”
Also relating to delays in scheduled PAMA cuts, the 2023 PFS proposes that, for CY 2022, payment may not be reduced by more than 0 percent, compared to the set amount for CY 2021. For CYs 2023 through 2025, payment won’t be reduced by more than 15 percent compared to the amount set for the previous year.
Lab specimen collection fee policies
In another key change affecting labs, CMS proposes to “codify and clarify” certain lab specimen collection fee policies in the Medicare Claims Processing Manual that are without corresponding regulations and for which the manual guidance no longer applies. CMS is also proposing new travel allowance requirements for specimen collection.
Other changes brought forth in the 2023 PFS involve expanded coverage of colorectal cancer screening and the removal of the 3 percent increase for fee schedule payments to help physicians manage COVID-19-related revenue losses. Regarding PFS payments, CMS is proposing a conversion factor of $33.08 for CY 2023, a drop of $1.53 compared to the CY 2022 PFS conversion factor of $34.61.
For a helpful summary of the key changes in the 2023 PFS, read this news story from TCL’s partner brand, G2 Intelligence.