Join us for an informative webinar on the CMS Physician Final Rule 2023, which will provide insights on the latest updates to physician payment and coding guidelines for the upcoming year. It is crucial for healthcare providers and staff to be aware of the key changes proposed by CMS and understand which items will be implemented in 2023. For all healthcare providers and offices that bill Medicare or Medicaid, staying up-to-date with CMS yearly changes is essential. This webinar will delve into the details of the CMS Physician Final Rule for 2023, outlining all the changes that providers and staff need to know. Don't miss this opportunity to gain critical insights into the CMS Physician Final Rule 2023 and ensure that your practice is prepared for the upcoming changes. Join us for a comprehensive overview of the new guidelines and their implications for physician offices. Register, https://conferencepanel.com/conference/cms-physician-final-rule-2023

1. Jan Rasmussen PCS, CPC, ACS-
OB, ACS-GI
Professional Coding Solutions
715.595.4278
janrpcs@aol.com
CMS 2023 Final
Rule
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2. • CY 2023 PFS conversion factor is
$33.06
–Decrease of $1.55 to the CY 2022 PFS
conversion factor of $34.61.
–Many E/M services had RVU reductions
from 2022 to 2023 due to category
deletions and combining of categories
2023 Conversion Factor
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3. • Extended 2021 documentation guidelines to determine a
level of E/M service to all additional EM services i.e.,
hospital inpatient, hospital observation, emergency
department, nursing facility, consults, home services/
residence services and cognitive assessment
– CMS accepted new documentation guidelines and E/M
code changes except for prolonged services.
• Deleted several code categories in conjunction with new
combined EM categories.
• Eliminated codes with same decision making levels.
2023 CPT E/M Changes
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4. • Deleted Hospital Observation Services E/M
codes 99217-99220
• Deleted Domiciliary, Rest Home (e.g., Boarding
Home/Assisted Living), or Custodial Care
Services E/M codes 99324-99238, 99334-
99337, 99339, 99340
• Deleted Consultations E/M codes 99241 and
99251
Deleted Codes and Categories
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5. • Hospital Inpatient/Observation Care Category
– Codes 99221-99223 and 99231-99233 now include both
inpatient and observation care
– Same day codes 99234-99236 also now apply to both
inpatient or observation care
• New CMS add on code G0316 for inpatient/observation
prolonged service to be reported in conjunction with 99223,
99233 or 99236
– Do not report G0316 for any time unit less than 15
minutes
– Do not report G0316 on the same date of service as
other prolonged services for evaluation and management
codes 99358, 99359, 99418, 99415, 99416)
Combined Categories
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6. • New CMS prolonged attendance add on code
G0318 code for home/residence prolonged service
to be reported in conjunction with 99345 or 99350.
– Do not report G0318 for any time unit less than 15
minutes
– Do not report G0318 on the same date of service as
other prolonged services for evaluation and
management codes 99358, 99359, 99417
Home/Residence Services Changes
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7. • New CMS add on code G0317 code for prolonged
nursing facility service to be reported in
conjunction with 99306 or 99310.
– Do not report G0317 for any time unit less than
15 minutes
– Do not report G0317 on the same date of
service as other prolonged services for 99358,
99359, 9941
Prolonged Services Changes…
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8. • Split shared care may be billed by the provider that
furnishes the substantive portion of a hospital or
nursing facility visit.
• CMS requirements for split shared care in 2023
remain the same as 2022.
– Clinicians who furnish split (or shared) visits will continue
to have a choice of history, physical exam, or medical
decision making, or more than half of the
total practitioner time spent to define the substantive
portion
– Initially intended to require time as the determining factor
of “substantive portion” in 2023
Split Shared Care
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9. • Made several services temporarily
available as telehealth services for
the PHE available through CY 2023
on a Category III basis
–Allow more time for collection of data
that could support their eventual
inclusion as permanent additions to the
Medicare telehealth services list.
Telehealth
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10. • Continues to be available for mental health patients in their
homes after the end of PHE and the 151day post-PHE
extension period.
– When a mental health practitioner furnishes a service using audio-
only technology, they would bill for the same service they would bill
if the service had been furnished in person.
• Telephone E/M services would not be the same as in-
person care; nor would they be a substitute for a face-to-
face encounter.
– Will not be paid after the end of the PHE and the 151-
day post-PHE extension period.
– Will be assigned “bundled” status.
Telephone Only (99441-9943)
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11. • No existing CPT code that specifically describes the work
and potential resources of a clinician who performs
comprehensive, holistic CPM.
– Chronic pain generally defined as persistent or recurring pain lasting
longer than three months
– Often require longer office visit times, longer follow-up coordinating
care with social workers and case managers, mental and behavioral
health support, communications with emergency department
physicians and nurses, and numerous medication adjustments
• Prompt more practitioners to welcome Medicare
beneficiaries with chronic pain
• Expect most services to be billed by primary care providers
Chronic Pain Management
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12. • CMS’s goal to reduce existing barriers to mental health
issues and make greater use of services of behavioral
health professionals, such as licensed professional
counselors (LPCs) and Licensed Marriage and Family
Therapists (LMFTs).
• Currently no separate benefit category under Medicare
statutes that recognizes the professional services of
licensed professional counselors (LPCs) and Licensed
Marriage and Family Therapists (LMFTs).
– Payment for the services of LPCs and LMFTs can only be made
indirectly when an LPC or LMFT performs services as auxiliary
personnel incident to, the services, and under the direct
supervision, of the billing physician or other practitioner.
Behavioral Health Services
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13. • Increased overall payments non-drug component G2074
for medication-assisted treatment and other treatments
for OUD, recognizing the longer therapy sessions that
are usually required.
– Code description does not state 45 minutes
– Increase the current crosswalk to describing a 45
minute session rather than a 30 minute session
• Allow OTP intake add-on code, G2076 to be furnished
via two-way audio video communications technology
when billed for the initiation of treatment with
buprenorphine and for periodic assessments
• Increase of $24.39 codes G2067-G2075
Opioid Treatment Programs…
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14. • Allow direct access for certain diagnostic audiology
services, when appropriate, to an audiologist without
a physician referral by creating a new HCPCS code
(GAUDX).
– New Code GAUDX not in final rule due to comments
received.
– Instead initiated new modifier –AB to be used with codes
already used by audiologists to identify audiology services
furnished without the order of a physician or NPP.
– Establish system edits through usual change management
process to ensure that HCPCS codes billed with modifier –
AB is only paid once every 12 months per each
beneficiary.
Audiology Services
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15. • Dental services are generally not covered by Medicare.
• Exception: Inpatient hospital services with treatment, filling,
removal or replacement of teeth or structures supporting
the teeth when the patient has an underlying medical
condition or the severity the procedures
• Dental services may be paid as necessary treatment,
performed as part of a comprehensive workup prior to
organ transplant surgery, or prior to cardiac valve
replacement or valvuloplasty procedures, that are
inextricably linked to, and substantially related and integral
to the clinical success of certain other covered medical
services
– Eliminate oral or dental infection prior to the above procedures
Dental & Oral Health Services
16

16. • Ten products are as follows:
– NovoSorb® SynPath™
– Restrata®
– Wound Matrix
– Symphony™
– InnovaMatrix™ AC
– Mirragen® Advanced Wound Matrix
– bio-ConneKt® Wound Matrix
– TheraGenesis®
– XCelliStem®
– Microlyte® Matrix
– Apis® (86
Skin Substitutes…
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17. • Requiring Manufacturers of Certain Single-dose
Container or Single-use Package Drugs to
Provide Refunds with Respect to Discarded
Amounts
– Many drugs and biologicals (hereafter referred to as a
drugs) payable under Medicare Part B are dosed in a
variable manner such that the entire amount identified
on the vial or package is not administered to the patient
• Often times, these drugs are available only in single-dose
containers designed for use with a single patient as a single
injection or infusion
Discarded Drugs
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18. • Now covered in RHC and FQHC chronic
pain management (G3002) and
behavioral health integration services
(G0323) under G0511.
– When CPs and CSWs furnish the services described in HCPCS
code G0323 in an RHC or FQHC, they can bill HCPCS code
G0511.
– May be billed alone or with other payable RHC or FQHC
services
RHC & FQHC
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