The Centers for Medicare and Medicaid Services (CMS) released its final rules for 2023 Medicare payments.
Good news! The full CRC continuum will be covered in Medicare.
In a win for patients and thanks to our collective advocacy efforts from AGA and partner societies, CMS expanded the regulatory definition of “colorectal cancer screening tests” and will waive cost sharing for a necessary follow-up colonoscopy after a positive stool-based screening test.
Bad news: Looming cuts on the horizon, GI societies to take action
The rule finalizes more than 4% in mandated Medicare physician reimbursement cuts through decreases in the conversion factor and expiration of temporary fixes passed by Congress. The CY 2023 conversion factor is $33.06, an unacceptable cut for our members. The GI societies continue to work with a coalition of national and state medical societies to urge Congress to prevent these cuts before Jan. 1, 2023.
Good news: ASC + hospital payments on the rise
ASC payments and facility fee payments increase 3.8% for institutions that meet quality reporting requirements. The CY 2023 ASC conversion factor is $51.854 and the hospital outpatient conversion factor is $85.585.
CMS removed motility codes 91117 and 91122 from APC 5731, where their payments would have been cut 21%, and finalized their placement in APC 5722, where they get a 3% payment increase beginning Jan. 1, 2023. Thank you to the motility community for helping us secure this win.
CMS raises the hospital payment for ESD code C9779 to $3,260.69, a $765.65 increase from 2022. We continue to work with CMS on our request for separate codes for lower ESD and upper ESD and payments that better reflect their unique resource costs.
CY 2023 Medicare Physician Payment Charts
- 2023 MPFS Final Rule Payment Changes
- 2023 MPFS Final Rule RVU Changes
- 2023 Final Rule ASC Payment Changes
- 2023 Final Rule ASC Top 10 Base and Biopsy Codes
- 2023 Final Rule Hospital Outpatient Payment Changes
- 2023 Final Rule Hospital Outpatient Top 10 Base and Biopsy Codes
CMS Rules and Fact Sheets