Proposed PFS chops fees 4%, approves E/M remake, previews code changes

Why This Topic Matters

The proposed rule touches multiple high-impact billing areas that can affect reimbursement, compliance, and operational planning across physician practices and facility settings. Coding and reimbursement professionals need to understand the scope of the proposed changes to assess whether the rule affects their specialties and workflows.

Article Sections

1. Medicare physician fee schedule overview

   Introduces the proposed 2023 Medicare physician fee schedule and summarizes the broad categories of payment and coding changes discussed in the article.

2. Payment changes for procedure codes

   Discusses projected fee schedule impacts on selected procedure services, including orthopedic items and other common billed procedures.

3. Facility-based E/M fees set for big changes

   Covers proposed revaluation of facility-based evaluation and management visit services and related updates to hospital, emergency department, and consultation coding topics.

4. Other key proposals in the proposed 2023 fee schedule

   Summarizes additional proposals affecting remote therapeutic monitoring, split/shared visits, same-day E/M billing policies, and consultation coverage.

5. Tighter enrollment process in the works for DMEPOS suppliers

   Reviews proposed enrollment and revocation policy changes for durable medical equipment, prosthetics, orthotics, and supplies suppliers, including ownership- and exclusion-related concerns.

6. Single-dose drug units

   Explains proposed modifier and drug-wastage policy updates related to Part B drug billing and claims reporting.

7. Introducing pain management, behavioral health codes to rural health centers (RHC) and federal qualified health centers (FQHC)

   Describes proposed new G-code concepts and related policy updates for rural health centers and federally qualified health centers, including behavioral health and chronic pain management topics.

8. Revaluing post-op visits: CMS is seeking comment

   Summarizes CMS’s request for public input on valuation of global surgical packages and postoperative visit services.