The Centers for Medicare and Medicaid Services (CMS) has released the 2024 Medicare Physician Fee Schedule proposed rule and fact sheet. The rule once again features more payment cuts even after Congress allowed for an additional 1.25% for 2024.

Conversion Factor 

For 2024, CMS is proposing a conversion factor of $32.75, compared to $33.89 in 2023. Part of the reason for this decrease is the expiration of an increase added to the 2023 fee schedule by Congress. Additionally, budget neutrality changes stemming from clinical labor costs and value increases to an evaluation and management add-on code G2211 add to the reduction.

G2211  

In the proposed rule, CMS has brought back its proposal for an add-on code, G2211, that would be used in addition to evaluation and management services for additional complexity stemming from primary care or ongoing care of complex chronic conditions. The code was originally introduced for 2021 but was blocked by Congress until 2024 as part of legislation to reduce payment cuts.

Request for Information of Valuing Services 

CMS is requesting public comment on ways to improve the accuracy on valuing services in the future. CMS is seeking information on ways to improve data collection and make better evidence-based decisions on code values and has included a list of questions for commenters to consider, including what the consequences are for misvalued codes, and if the current CMS and AMA RUC processes accurately value codes.

Telehealth 

The services on the telehealth list only through the end of the current public health emergency will now be extended through December 31, 2024 along with the provision for site of service to include the patient’s home. Services rendered in the home will also continue to be paid at the non-facility, office-based rate.

Venography 

In the proposed rule, CMS has valued five new CPT® add-on codes for venography. However, CMS did not accept AMA RUC value recommendations for two of the codes 9X004 and 9X005 for venovenous collaterals.

Percutaneous Transluminal Coronary Lithotripsy 

In the proposed rule, CMS has valued a new CPT add-on code for percutaneous transluminal coronary  lithotripsy. CMS accepted the AMA RUC value recommendation.

Merit-Based Incentive Program (MIPS) 

CMS has proposed changes to the performance threshold for the 2024 performance year. It will increase from 75 points to 82 points. The data completeness threshold will remain at 75 percent. A new cost measure for heart failure has also been proposed.

CMS has proposed several changes to the Cardiology Specialty Measures set. The rule proposes adding two measures: An equity measure, Connection to Community Service Provider, and Gains in Patient Activation Measure (PAM®) Scores at 12 Months. CMS is also proposing to remove three measures: Measure 128, Body Mass Index Screening and Follow-up Plan, Measure 324, Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Testing in Asymptomatic, Low-Risk Patients, and Measure 402, Tobacco Use and Help with Quitting Among Adolescents.

MIPS Value Pathways (MVPs) 

CMS has proposed changes to the Advancing Care for Heart Disease MVP, including the addition of four quality measures, three new improvement activities, and two cost measures.

CMS is accepting public comment on the proposed rule for 60 days from the final publication date. SCAI will continue to analyze the rule and will provide comments to CMS.

SCAI continues to fight the payment cuts through both regulatory and legislative channels, including the support of H.R. 3674 and the Providing Relief and Stability for Medicare Patients Act of 2023, which would help to offset the cuts. SCAI’s Government Relations Committee and its political arm, SCAI PAC, will be reviewing the effects of these cuts and providing more information to SCAI members for further action in the near future.