CMS has finalized the rules for the 2023 Hospital Outpatient Prospective Payment System (HOPPS) and Medicare Physician Fee Schedule (MPFS). Please see below for some key information impacting diagnostic imaging payments for 2023.
For more information on the HOPPS final rule, you can find the CMS Fact Sheet here.
For more information on the MPFS final rule, you can find the CMS Fact Sheet here.
CY 2023 PFS Ratesetting and Conversion Factor
CMS is finalizing a series of standard technical proposals involving practice expense, including the implementation of the second year of the clinical labor pricing update. CMS also included a comment solicitation seeking public input to develop a more consistent, predictable approach to incorporating new data in setting PFS rates. Per statutory requirements, CMS is also updating the data used to develop the geographic practice cost indices (GPCIs) and malpractice relative value units (RVUs).
With the budget neutrality adjustments, which are required by law to ensure payment rates for individual services don’t result in changes to estimated Medicare spending, the required statutory update to the conversion factor for CY 2023 of 0%, and the expiration of the 3% supplemental increase to PFS payments for CY 2022, the final CY 2023 PFS conversion factor is $33.06, a decrease of $1.55 to the CY 2022 PFS conversion factor of $34.61.
CY 2023 HOPPS Finalized Imaging Ambulatory Payment Classifications (APCs)
For CY 2023, CMS has not changed the structure of the seven imaging APCs.