2023 MPFS proposed rule: Preview CPT coding and payment changes

Why This Topic Matters

The proposed rule signals upcoming changes that can affect reimbursement, documentation workflows, reporting requirements, and code selection across multiple specialties. Understanding the scope of the proposal helps organizations prepare for operational and compliance updates before the policy year begins.

Article Sections

1. Overview of the 2023 MPFS proposed rule

   Introduces the proposed Medicare Physician Fee Schedule changes and the major policy areas addressed in the article. Summarizes the broad payment and reporting themes relevant to Part B providers.

2. Aligning with recent E/M changes

   Discusses CMS alignment with recent office and other E/M guideline updates. Covers the general direction of proposed changes affecting office, inpatient, observation, and related settings.

3. Additional MPFS proposals

   Reviews a group of additional proposed updates spanning new CPT services, potentially misvalued codes, E/M work RVU adjustments, telehealth reporting, split/shared services, and global surgical package valuation.

4. Medicare Shared Savings program

   Summarizes proposed changes for ACO participation, incentives, and support under the Shared Savings program. Focuses on low-revenue ACOs, underserved populations, and risk-track policy updates.

5. Quality payment program/merit-based incentive payment system (QPP/MIPS)

   Covers proposed updates to MIPS scoring, MVPs, participation rules, thresholds, and related reporting incentives. Also notes requested input on quality measure topics and health equity-related issues.

6. Vaccine administration

   Describes proposed vaccine administration payment and coverage adjustments for 2023. Includes continuing COVID-19-related coverage considerations and payment factor updates.

7. Innovations in dental, audio, behavioral, and pain management care

   Outlines proposals affecting services in dental, audiology, behavioral health integration, and pain management. Highlights CMS interest in expanded coverage and new service concepts in these areas.

8. More on prolonged care

   Explains CMS’s proposed approach to prolonged care services in several settings. Compares the agency’s proposed prolonged service framework with related E/M reporting concepts.