2023 Physician Fee Schedule Includes CPT Changes in Coding and Documenting for Nursing Facility Codes

On July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the 2023 Medicare physician payment schedule. While members of the Society’s staff analyze and develop a summary of the 2,000+-page proposal, we want to make you aware of a few key issues. Notably, CMS is adopting changes to CPT coding and documenting for evaluation and management codes, including nursing facility codes. Thanks to the many Society members who participated in a 2019 survey of the nursing facility codes to help the RUC develop and recommend these changes to CMS.

The following table shows the changes to the nursing facility codes Work RVU valuation:

This second table shows the predicted payment rates given the proposed changes (these are subject to change following further evaluation and finalization of the rule). The 2023 Medicare conversion factor would be reduced by about 4.5%, from $34.6062 to $33.0775. This is largely a result of the expiration of a 3% increase to the conversion factor at the end of calendar year 2022 as required by law.

CMS is proposing that when total time on the date of encounter is used to select the appropriate level of a nursing facility visit service code, both the face-to-face and non-face-to-face time personally spent by the physician (or other qualified health-care professional) assessing management of the patient are summed to select the appropriate code to bill. Additionally, the codes have new descriptor times, assigned for when time is used to select visit level. Initial nursing facility care (CPT 99304-99306) may be used once per admission, per practitioner, regardless of the length of stay in the SNF/NF. CMS is also proposing to remove code 99318 (annual NF assessment).

Also of note, nursing facility initial services (99304-99306) will be removed from the telehealth list 151 days after the public health emergency ends. However, CMS’ memo issued on April 7 and effective May 7 stated that all regulatory visits must be done in person. Given that the initial visit is one of those regulatory visits per long-standing CMS policy, the Society interpretation is that you must apply for an 1135 waiver in order to use it. See this webpage for information on regulatory required visits.

The Society will continue to analyze the proposed rule and prepare a summary of important changes for members soon.

Read the CMS summary of the proposed rule.