On November 1st, the Centers for Medicare & Medicaid Services (CMS) announced the final rule for the 2023 Medicare Physician Fee Schedule (PFS), meaning changes across all healthcare specialties, including physical therapy, occupational therapy, speech-language pathology, applied behavioral analysis, and more.

What Can Your Therapy and Rehab Practice Expect for 2023?

Starting January 1st, 2023, the conversion factor will be decreased by $1.55 to $33.06, making this cut a 4.48% reduction in payment. This financial change will especially impact practices that offer care in more rural areas where the number of Medicare beneficiaries may outweigh patients on different insurance plans. Not only will practices be faced with potential closure, but patients in need of healthcare may no longer have access to their providers.

While this is by far one of the most impactful changes that the upcoming year brings, there are other policy updates and changes to take note of as well.

More Opportunities for Chronic Pain Management

Additionally, new HCPCS codes, G3002 and G3003, and valuation for chronic pain management and treatment services (CPM) have been finalized. These new codes are intended to encourage more practitioners to welcome Medicare beneficiaries with chronic pain into their practices as well as provide more healthcare options for managing chronic pain for patients.

Changes to Telehealth

As of right now, the PHE is set to expire on January 11, 2023, and the Consolidations Act of 2022 has taken steps to ensure that the telehealth policies that have been put in place as a result of the pandemic will continue for 151 days after expiration. CMS has expanded on that further by allowing coverage for telehealth services that fall under Category 3 to continue until the end of 2023. This grants CMS the time to collect more data on whether these services offer a clinical benefit beyond a public health emergency.

Coverage for telehealth services that will expire after the 151-day period following the end of the PHE:

  • Eye exams for new patients
  • Initial observation care
  • Initial hospital care
  • Initial nursing facility care
  • Home visits for new patients
  • Initial neonatal or pediatric critical care

Additionally, the payment amount for Telehealth Originating Site Facility Fee has increased 3.8% from $27.59 in 2022.

Update for Audiologists

CMS has finalized a policy that allows patients to access an audiologist for certain services without an order from a physician for non-acute hearing conditions. These services include evaluation exams for the purpose of prescribing, fitting, or changing out hearing aids, but will not apply to balance assessments for patients experiencing equilibrium.

Furthermore, this policy comes with a new modifier that should help with reporting accuracy, permitting audiologists to bill for direct access without an order once every 12 months per beneficiary.

How Can Your Practice Prepare for the Updated Conversion Factor in CY 2023?

With significantly reduced payments on the horizon, it’s more important than ever to take steps that can make your practice’s revenue airtight. For more information on how to ensure that your practice is taking full advantage of automated, accurate, and fast payments, check out our resources:

Bracing your practice against these budget cuts is only a part of future-proofing your business. This 4.5% payment cut is indicative of CMS’s intent to continue reducing payment up to 9% by 2024, further preventing Medicare beneficiaries from receiving the care they need and forcing providers to make tough business choices that put patients at risk.

By encouraging your Member of Congress to support The Supporting Medicare Providers Act of 2022, we can fight for an additional 4.42% to the conversion factor for 2023, stabilizing practices under financial duress as a result of these budget cuts and continuing to offer quality care to Medicare beneficiaries.

With Raintree’s strategic partnership with the Alliance for Physical Therapy Quality and Innovation (APTQI), we share a common goal to provide patients with efficient and excellent care. Take a stand with us and urge your Member of Congress to support and pass The Supporting Medicare Providers Act of 2022!