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CMS CY 2023 OPPS Proposed Rule

CMS CY 2023 OPPS Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) released both the CY 2023 Physician Fee Schedule Proposed Rule and the Hospital Outpatient Prospective Payment System/Ambulatory Surgical Center Payment System Proposed Rule. The proposed rules solicit public comments on proposed policy changes for Medicare payments and payment policy issues. Key provisions of the proposals include the following:

  • The proposed CY 2023 PFS conversion factor is $33.08, a decrease of $1.53 to the CY 2022 PFS conversion factor of $34.61
  • Revised coding and updated guidelines for Other E/M visits
  • Proposing several services that are temporarily available as telehealth services for the PHE available as permanent additions to the Medicare telehealth services list
  • Expand Medicare coverage for certain colorectal cancer screening tests by reducing the minimum age payment limitation to 45 years, and proposing to expand the regulatory definition of colorectal cancer screening tests

Hospital Outpatient Prospective Payment System/Ambulatory Surgical Center Payment System Proposed Rule (OPPS/ASC):

  • Update OPPS payment rates for hospitals that meet applicable quality reporting requirements by 2.7%. This update is based on the projected hospital market basket percentage increase of 3.1%, reduced by 0.4 percentage point for the productivity adjustment
  • Add one procedure, a lymph node biopsy or excision, to the ASC Covered Procedures List (CPL)
  • CMS is proposing to update the Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery (ASC-11) measure to be voluntary for the ASC Quality Reporting (ASCQR) Program

CMS is actively seeking comment on the CY 2023 Proposed Rules with final ruling expected fall of 2022.

 

2023 Medicare Physician Fee Schedule Proposed Rule Read More

CY 2023 Medicare Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment System Proposed Rule (CMS 1772-P) Read More

 


This post was published July 19, 2022.

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