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Cuts in store: 2024 proposed Medicare payments

While a disappointing payment reduction is proposed, the rules also included some positive changes.
Medicare health insurance stock photo
Medicare health insurance stock photo

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. Watch for alerts on our advocacy efforts and how you can help.

The proposed rules also included positive news, including increased facility fees, new codes to increase health equity and telemedicine reimbursement.

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.

Additional resources

For more information, see the GI societies’ summaries: Medicare Physician Fee Schedule (MPFS) and Medicare Hospital Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC).

CY 2024 Medicare Proposed Physician Payment Charts

CMS Medicare Physician Fee Schedule Proposed Rule and Fact Sheets

CY 2024 Medicare Proposed Hospital Outpatient and ASC Payment Charts

CMS Hospital Outpatient and ASC Proposed Rule and Fact Sheets

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