On July 7, 2022, CMS released the Calendar Year (CY) 2023 Physician Fee Schedule (PFS) proposed rule (the Proposed Rule). The Proposed Rule includes proposed policy changes for Medicare payments under the Physician Fee Schedule and other Medicare Part B issues for claims occurring on or after January 1, 2023. According to CMS, the Proposed Rule changes aim to create a more equitable health care system resulting in better accessibility, quality, affordability, and innovation. Comments to the Proposed Rule are due by 5:00 p.m. on September 6, 2022.
Some of the proposed changes are highlighted below.

• CY 2023 PFS Rate Setting and Conversion Factor. CMS is proposing that the CY 2023 PFS conversion factor be $33.08, a decrease of $1.53 from the CY 2022 PFS conversion factor of $34.61. This proposed amount reflects the 0.0 percent required statutory update, the expiration of the 3.0 percent increase in PFS payments for CY 2022, and budget neutrality adjustments to ensure payment rates for individual services do not result in changes to estimated Medicare spending.
• Evaluation and Management (E/M) Visits. CMS is proposing to adopt most of the changes in coding and documentation for Other E/M visits approved by the AMA CPT Panel, effective January 1, 2023. This revised coding and documentation would include changes to CPT code definitions, including new descriptor times, revised interpretive guidance for levels of medical decision making, choice of medical decision making or time to select code level, and elimination of the use of history and exam to determine code level.
• Delay to Split (or Shared) E/M Visits Provided in the Facility Setting. CMS is proposing a one-year delay to the split (or shared) visits policy, which would have required more than half of total practitioner time to be spent by the billing provider to constitute the substantive portion for all split (or shared) services beginning on January 1, 2023. Instead, for CY 2023, as in CY 2022, with the exception of critical care visits, the proposed rule would continue to permit any of the following to constitute the substantive portion of the visit: history, physical examination, making a medical decision, or spending time (more than half of the total time spent by the practitioner who bills for the visit). Delaying implementation of this policy allows for a one-year transition for providers to acclimate to the new changes and adopt workflow changes. The delay will also provide stakeholders an opportunity for further comment on this policy. CMS is also proposing a number of technical corrections to policies for split (or shared) visits, including relocating the proposed definition of split (or shared) visits and clarifying critical care billing policies to state that CPT code 99292 could be billed after 104, not 75, or more cumulative total minutes spent providing critical care.
• Updated Medicare Economic Index (MEI). CMS is soliciting comments on a proposed revision to the MEI cost share weights, which measure the input price pressures of providing physician services. CMS is proposing a new methodology for estimating base year expenses that relies on publicly available data from the U.S. Census Bureau NAICS 6211 Offices of Physicians, which would allow for the use of data that are more reflective of current market conditions of physician ownership practices, rather than only reflecting costs for self-employed physicians, and will allow for the MEI to be updated on a more regular basis.
• Telehealth Services. CMS is proposing to implement the telehealth provisions in the 2022 Consolidated Appropriations Act and extend certain flexibilities in place during the public health emergency (PHE) for 151 days after the PHE ends, including: allowing telehealth services to be furnished in any geographic area and in any originating site setting, including the beneficiary’s home; allowing certain services to be furnished via audio-only visits; and allowing physical therapists, occupational therapists, speech-language pathologists, and audiologists to furnish telehealth services. CMS is also proposing to delay the in-person visit requirements for mental health services furnished via telehealth until 152 days after the end of the PHE.
• Behavioral Health Services. In light of the increased needs for mental health services, CMS is proposing to create a new General Behavior Health Integration (BHI) service personally performed by clinical psychologists (CPs) or clinical social workers (CSWs) to account for monthly care integration where the services furnished by a CP or CSW serve as the focal point of care integration, and to allow a psychiatric diagnostic evaluation to serve as the initiating visit. CMS is proposing to make an exception to the direct supervision requirement under its “incident to” regulation to allow behavioral health services provided under the general supervision of a physician or NPP, rather than under direct supervision, when these services are provided by auxiliary personnel incident to the services of a physician or NPP.
• Chronic Pain Management Services. CMS is proposing new HCPCS codes and valuation for chronic pain management and treatment services (CPM) for CY 2023. CMS is proposing to include elements in the CPM code, such as: the diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development and maintenance of a person-centered care plan; treatment management; behavioral health treatment; medication management; pain and health literacy counseling; chronic pain related crisis care; and ongoing communication and coordination between relevant practitioners. CMS is also proposing to add the new chronic pain management and behavioral health integration services to the RHC and FQHC specific general care management HCPCS code.
• Opioid Treatment Programs (OTPs). CMS is proposing to revise its methodology for pricing the drug component of the methadone weekly bundle and the add-on code for take-home supplies of methadone to stabilize the price for methadone for CY 2023 and subsequent years. CMS is proposing to modify the payment rate for the non-drug component of the bundled payments for episodes of care to base the rate for individual therapy on a crosswalk code for a 45-minute session, instead of a code for a 30-minute session. CMS is also proposing to allow the OTP intake add-on code to be furnished via two-way audio-video communications technology when billed for the initiation of treatment with buprenorphine, and to allow the use of audio-only communication technology to initiate treatment with buprenorphine when audio-video technology is not available. Additionally, CMS is clarifying that OTPs can bill Medicare for medically reasonable and necessary services furnished via mobile units, and CMS is proposing that locality adjustments for services furnished via mobile units would be applied as if the service were furnished at the physical location of the OTP.
• Audiology Services. CMS is proposing to allow beneficiaries to have direct access, when appropriate, to an audiologist without a physician referral by creating a new HCPCS code for audiologists to bill for audiology services personally furnished by the audiologist including care for non-acute hearing or assessments unrelated to disequilibrium, hearing aids, or examinations for prescribing, fitting, or changing hearing aids. CMS is proposing to permit audiologists to bill for this direct access without a referral once every 12 months.
• Dental and Oral Health Services. CMS is seeking comment on proposed payment for other dental services, such as dental exams and necessary treatments prior to organ transplants, cardiac valve replacements, and valvuloplasty procedures that may be inextricably linked to, and substantially related and integral to, the clinical success of an otherwise covered medical service. CMS is also requesting comment on possible payment models for dental and oral health care services, and other impacted policies.
• Skin Substitutes. CMS is proposing to change the terminology of skin substitutes to ‘wound care management products’ in order to accurately reflect how clinicians use these products, and to provide a more consistent and transparent approach to coding and paying for these products as incident to supplies under the PFS, effective January 1, 2024. CMS is seeking feedback on key objectives related to skin substitute policies, including (1) ensuring a consistent coding and payment approach for skin substitute products across the physician office and hospital outpatient settings; (2) ensuring that all skin substitute products are assigned an appropriate HCPCS Level II code; (3) using a uniform benefit category across products within the physician office setting; and (4) maintaining clarity for interested parties on CMS skin substitutes policies and procedures.
• Colorectal Cancer Screening. CMS is proposing to expand Medicare coverage for certain early detection services colorectal cancer screening tests by reducing the minimum age payment limitation to 45 years and expanding the regulatory definition of colorectal cancer screening tests to include a follow-on screening colonoscopy after a positive stool-based colorectal cancer screening test result.
• Manufacturer Refund for Discarded Amounts of Certain Single-Dose Container or Single-Use Package Drugs. CMS proposes to implement a recent statutory change to require manufacturers to provide a refund to CMS for certain discarded amounts from a single-dose container or single-use package drug that exceeds an applicable percentage of at least 10% of total allowed charges for the drug in a given calendar quarter.
• Preventive Vaccine Administration Services. CMS is proposing to annually update the payment amount for preventive vaccine administration under the Medicare Part B vaccine benefit based upon the increase in the MEI and to adjust for the geographic locality, based upon the PFS locality where the preventive vaccine is administered using the geographic adjustment factor. CMS is also proposing to continue the additional payment for at-home COVID-19 vaccinations for CY 2023. In addition, CMS is proposing to clarify that its policies in the CY 2022 PFS final rule regarding the administration of COVID-19 vaccine and monoclonal antibody products will continue until the termination of the Emergency Use Authorization declaration for drugs and biological products under the Food, Drug, and Cosmetic Act.
• Conforming Technical Changes to the In-Person Requirements for Mental Health Visits. CMS is proposing to implement conforming regulatory text changes to include the delay of the in-person requirements for mental health visits furnished by RHCs and FQHCs through telecommunication technology under Medicare until the 152nd day after the COVID-19 PHE ends.
• Specified Provider-Based RHC Payment Limit Per-Visit. CMS is proposing to clarify that a 12-consecutive month cost report should be used to establish a specified provider-based RHC’s payment limit per visit.
• Clinical Laboratory Fee Schedule (CLFS). CMS is proposing to make certain conforming changes to the data reporting and payment requirements including: (1) specifying that for the data reporting period of January 1, 2023 through March 31, 2023, the data collection period is January 1, 2019 through June 30, 2019; (2) indicating that initially, data reporting begins January 1, 2017 and is required every 3 years beginning January 2023; (3) indicating that for CY 2022, payment may not be reduced by more than 0% as compared to the amount established for CY 2021, and for CYs 2023 through 2025, payment may not be reduced by more than 15% as compared to the amount established for the preceding year; and (4) codifying and clarifying various laboratory specimen collection fee policies. In addition, CMS is proposing changes to the Medicare CLFS travel allowance policies to reflect the requirements for the methodology for travel allowance for specimen collection.
• Medicare Ground Ambulance Data Collection System. CMS is proposing changes to the Medicare Ground Ambulance Data Collection System to reduce burden on respondents and/or improve data quality. Specifically, CMS is proposing to update its regulations to provide flexibility to specify how ground ambulance organizations should submit hardship exemption requests and informal review requests, including to CMS’s web-based portal once that portal is operational. CMS is also proposing further changes and clarifications to the Medicare Ground Ambulance Data Collection Instrument, including editorial changes for clarity and consistency, updates to reflect the web-based system, clarifications responding to feedback from questions from interested parties and testing, and typos and technical corrections.

The Proposed Rule is expected to be published in the Federal Register on July 29, 2022. Please click here for a display copy of the Proposed Rule. The CMS fact sheet on the Physician Fee Schedule Proposed Rule can be found here.