CMS Releases Updated Conversion Factor; Be Prepared for 2023 Coding Changes

The Centers for Medicare & Medicaid Services (CMS) has released updated national Medicare physician payment files that incorporate the changes from the Consolidated Appropriations Act of 2023. Specifically, in response to concerted advocacy by the Society and other national medical associations, Congress reduced the 4.5% cut to Medicare physician payments by increasing the 2023 conversion factor by 2.5%. The updated 2023 Medicare physician payment schedule conversion factor will be $33.8872. The previously finalized conversion factor was $33.0607. The 2022 conversion factor was $34.6062. Below is a table of nursing facility codes and how the new conversion factor affects the payment rates for each:

Changes to Coding

As part of the ongoing updates to E/M visit codes and related coding guidelines that are intended to reduce administrative burden, the AMA CPT Editorial Panel approved revised coding and updated guidelines for Other E/M visits, effective January 1, 2023. CMS finalized changes in coding and values for the proposed revised Nursing Facility Visits E/M code set. This code set is effective beginning in CY 2023, and the proposed values will go into effect with those codes as of January 1, 2023. CMS finalized 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 that is reporting the office visit) assessing and managing 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.

In order to help members better prepare for the 2023 changes to coding and documentation guidance for current procedural terminology (CPT) evaluation and management services in PALTC, the Society continues to make available the popular webinar discussing the changes. The 2023 revisions to CPT evaluation and management services, including those for nursing facility services and assisted living facility services, will be among the most significant changes to CPT descriptors in decades.

The AMDA webinar focuses on those changes as well as other important aspects of documentation and coding in PALTC. The goal of the webinar is to help prepare participants to implement 2023 coding and documentation guidance for CPT evaluation and management services in PALTC. Access the webinar now; it is free for members.

Part two of the billing and coding webinar will take place on Tuesday, January 24, at 7:00 PM ET. Register now.