Thursday, July 7, 2022

CMS Posts Physician Fee Schedule Annual Proposed Rule for CY2023 (July 7, 2022)

 As occurs every summer, CMS posts the multi hundred page Physician Proposed Rule.  This year, it appeared on July 7, 2022.

This triggers a 60 day public comment period, and final decisions around November 1, effective January 1.

Find the Proposed Rule CY2023 here:

CMS initially publishes a "typescript" as above.  (See, "Download the published PDF."   The typeset rule will appear on July 29.  The "inspection copy" or "typescript" weighs in at 2066 pages.

See also a Fact Sheet summary, which is a lot shorter than 2066 pages.  But it's lengthy, at 4600 words.

There is also a press release, which typically includes some somewhat gassy claims about "expanding access to high quality care."

Early Press

Comment at RevCycle here.   Bloomberg Law here. Ophthalmology comment (angry) here.  Similarly at AMA here.  Healthleaders here.  MedPage here.  ASC Review here.  Healthcare Innovation here.  AHA here.  IRhythm press release here

One of the main themes is that CMS proposes circa 4% price cuts (RVU cuts) across the board, the result of financial and legislative rules, not individual decisions at CMS.  

One of the themes is better mental health integration in Medicare, see a separate article on that this week at Health Affairs here.

What's The New Stuff ?

Colonoscopy at age 45

Regulation 410.37 forbids screening colonoscopy payments before age 50.  USPSTF now recommends age 45.  The proposal aligns the regulation to age 45.

Pathology Quality Measure - MMR MSI

I haven't reviewed the whole rule yet but I note a pathology quality measure, page 1650, sponsored by CAP, for the percentage of colorectal cancer reports that include testing for MMR or MSI or both.

Lab Specimen Collection Pricing

There's a section that proposes to update some lab specimen collection rules and payments, page 539 ff to 575 (36pp!).

PAMA Rule Tweaks

Some tweaks to PAMA rules at 532 ff.  They seem to mostly be "conforming" (if Congress modifies PAMA by a year, CMS then modifies its PAMA regulation by a year in a mirror fashion).  

Copayments and Colon Cancer Screening

There have been some legislative changes in recent years that affect copayments when a copay-free screening colonoscopy encounters a polyp (a diagnostic polyp).   Notwithstanding those changes, some of which were in 2021, apparently a screening colonoscopy after a positive Cologuard test is still being considered a procedure "for cause" with a copay.  

CMS proposes to view this differently.  A colonoscopy screening episode will be viewed as "incomplete" if it stops at Cologuard, and "complete" if it encompasses both the Cologuard and the colonoscopy, both of which will be under the preventive services, and copay-free, umbrella.  Page 576 forward.


CMS proposes to nix an outdated NCD for ambulatory EEG.  The disappearance of the NCD, will mean the service is regulated by local LCDs.  Page 593-6.  

iRhythm Valuation Saga

Years-long battles over the RVU valuation of iRhythm patch (codes series 9324X) are settling down on terms not too unfavorable to iRhythm (page 195 forward).  It's an odd area where one stakeholder complained publicly to CMS that pricing was double or triple too high last year (eek).  

Digital Medicine

But there doesn't seem to be much discussion of machine learning or artificial intelligence, which was a big topic last year.   But one digital health topic, remote monitoring services, gets a lengthy treatment at 402 ff, proposing to make codes 98980/81 "non  payable by Medicare" (p. 406) with replacement G-codes.