The Centers for Medicare and Medicaid Services (CMS) have released proposed payment rules for physician services and facility fees for calendar year 2024. The GI societies are disappointed and concerned to see a proposed cut to reimbursement. The proposed rules also included positive news, including increased facility fees, new codes to increase health equity, and telemedicine reimbursement.
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Six takeaways for GI
- Cuts to physician payments: The CY 2024 Physician Conversion Factor (CF) is $32.75. This will result in a decrease of 3.36% in GI payment rates from this year’s $33.89. Note this is the proposed rule and the GI societies will advocate for increased rates before CMS finalizes the rule this fall.
- Increased facility fees: CMS proposes a 2.8% increase in facility payment rates overall, and we are happy to report GI increases are estimated to be about 6-8% higher than current rates.
- New codes to increase health equity: CMS proposes new codes and payment for several new services to help underserved populations. We applaud the Administration’s commitment to advance health equity and expand access to critical medical services.
- Telemedicine payments continue: In a positive move, CMS proposes several provisions including allowing telehealth visits to originate at any site in the U.S. (e.g., individual’s home), payment for audio-only services, and permanently including Social Determinants of Health Risk Assessments.
- No changes to split/shared visits policy: We’re also glad CMS proposes to delay through at least Dec. 31, 2024, the implementation of the definition of the “substantive portion” as more than half of the total time with the patient. Facilities can continue to use either one of the three key components (history, exam, or medical decision making) or more than half of the total time spent to determine who will bill for the visit.
- Proposed changes to colonoscopy interval measure for ASCs: Appropriately, CMS proposes to modify quality reporting program measures to align with the minimum age requirement for CRC screening in clinical guidelines.
For more information, see the GI societies’ summaries:
Medicare Physician Fee Schedule (MPFS)
Medicare Hospital Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC).
CY 2024 Medicare Proposed Physician Payment Charts
2024 Proposed Medicare Physician Payments
2024 Proposed Medicare Relative Value Unit Changes
CMS Medicare Physician Fee Schedule Proposed Rule and Fact Sheets
2024 Medicare Physician Fee Schedule Proposed Rule
2024 Medicare Physician Fee Schedule Proposed Rule Fact Sheet
CY 2024 Medicare Proposed Hospital Outpatient and ASC Payment Charts
2024 Proposed Medicare Hospital Outpatient Payments
2024 Proposed Medicare Hospital Outpatient Payments for Top 10 GI codes
2024 Proposed Medicare ASC Payments2024 Proposed Medicare ASC Payments for Top 10 GI codes
CMS Hospital Outpatient and ASC Proposed Rule and Fact Sheets
2024 Medicare OPPS/ASC Proposed Rule
2024 Medicare OPPS/ASC Fact Sheet