Each summer, CMS releases new omnibus packages of pricing policy and other rules, one for physician fee schedule (and other services like labs), and one for the hospital outpatient setting. In recent years, CMS has grappled with how to pay for AI-type services in either setting, and how to pay for molecular testing in the HOPPS setting, which sees increasing complications added to the 14 day rule.
CMS releases both packages of rules on July 13, 2023. The rules appear in typescript "inspection copies" today, and in the Federal Register in ten days. The rules come with CMS summaries in the form of CMS press releases. Both rules require massive spreadsheet attachments.
PHYSICIAN FEE SCHEDULE
HOSPITAL OUTPATIENT SCHEDULE
FLUFFY PRESS RELEASES
The PFS rule includes some conforming updates regarding PAMA, such as reporting in 1Q2024, lab prices and payments from 1H2019, to set a new 3-year price schedule in CY2025-26-27 Lab PAMA 431ff/1920.