The Centers for Medicare & Medicaid Services (CMS) released the final 2024 Medicare Physician Fee Schedule (PFS) rule, which in addition to major payment implications, includes changes to the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) participation options and requirements for 2024. The final rule:
- Sets the 2024 Medicare payment rates for physician services. For 2024, CMS finalized a conversion factor of $32.7442 and $20.4349 for Anesthesia (a decrease of -3.4% and -3.3%, respectively, from final 2023 rates);
- Implements E/M add-on code G2211 and defines the “substantive portion” of a split (or shared) E/M visit to mean more than half of the total time spent by the physician or nonphysician practitioner or a substantive part of the medical decision making;
- Reimburses telehealth services furnished to patients in their homes at the typically higher, non-facility PFS rate;
- Allows direct supervision by a supervising practitioner through real-time audio and video interaction telecommunications through 2024;
- Continues coverage and payment of telehealth services included on the Medicare Telehealth Services List through 2024;
- Pauses implementation and rescinds the Appropriate Use Criteria program regulations;
- Maintains the performance threshold of 75 points for all three MIPS reporting options;
- Adds five new MIPS Value Pathways related to women’s health, prevention and treatment of infectious disease, quality care in mental health/substance use disorder, quality care for ear, nose, and throat, and rehabilitative support for musculoskeletal care;
- Makes numerous changes to the Medicare Shared Savings Program (MSSP) such as revising the MSSP quality performance standard, modifying the program’s benchmarking methodology, and determining beneficiary assignment under the MSSP; and,
- Ends the 3.5% APM Incentive Payment after the 2023 performance year/2025 payment year, and transitions to a Qualifying APM Conversion Factor in the 2024 performance year/2026 payment year.
The calendar year 2024 PFS final rule is one of several final rules that reflect a broader Administration-wide strategy to create a more equitable health care system that results in better access to care, quality and affordability.