The 2023 Medicare Physician Fee Schedule (PFS) rule has arrived, released by the Centers for Medicare & Medicaid Services (CMS) on Tuesday, July 7, 2022. Radiology will once again experience a threat to payments as the pandemic continues to bring consequences for healthcare. As usual, the proposed rule outlines potential updates to a variety of policies and provisions that dictate payment for many services included in the Quality Payment Program (QPP), the Merit-Based Incentives Payment System (MIPS), and Advanced Alternative Payment Models (APMs). Keep in mind that these policies are proposed and will not be made final until the release of the final rule.
Once again, CMS has greeted healthcare with a woefully contradictory view for radiology of the proposed rule with CMS Administrator Chiquita Brooks-LaSure stating: “At CMS, we are constantly striving to expand access to high quality, comprehensive healthcare for people served by the Medicare program. Today’s proposals expand access to vital medical services like behavioral healthcare, dental care, and cancer treatment options, all while promoting access, innovation, and cost savings in the Medicare program.”
To further explain the conversation factor and the decision-making CMS went on to explain, “We are proposing a series of standard technical proposals involving practice expense, including the implementation of the second year of the clinical labor pricing update. We have also included a comment solicitation seeking public input as we develop a more consistent, predictable approach to incorporating new data in setting PFS rates. We hope to implement changes that will promote transparency and predictability in payment amounts. Per statutory requirements, we are also updating the data that we use to develop the geographic practice cost indices (GPCIs) and malpractice RVUs.”
However, the radiology community is about to be set for another year of reimbursement suffering if the proposed rule becomes final law or if further legislation isn’t passed. For 2023, CMS is projecting a conversion factor of $33.0775 as opposed to the 2022 conversion factor of $34.6062. The ACR notes that the calculations were made by “first removing the one-year 3 percent increase provided by the Protecting Medicare and American Farmers from Sequester Cuts Act and then applying a negative 1.55 percent budget neutrality update. The budget neutrality update appear to be largely related to increased values for several evaluation and management code families, including hospital, emergency medicine, nursing facility and home visits.”
This seemingly small decrease has a biting impact to radiology reimbursement. CMS projects a decrease of three percent for radiology. For interventional radiology a sharper aggregate decrease of four percent is expected. Nuclear medicine will see a blow of three percent. Meanwhile radiation oncology and radiation therapy centers will brace for a one percent decrease. Some circumstances around the decrease remain the adjustments in relative value units (RVUs) along with the second year of the transition to clinical labor pricing updates according to the College’s analysis. Furthermore, the ACR warns that “If Congress does not intervene to extend the three percent increase provided by the Protecting Medicare and American Farmers from Sequester Cuts Act, the percent decreases mentioned above will be greater for CY 2023.”
CMS is looking to make changes to the colorectal cancer screening services. Even more, they are examining policy updates to correlate with those updates that occurred with the United States Preventive Services Task Force (USPSTF). The USPSTF is looking to have screening start at age 45 as opposed to age 50. According to the ACR, “CMS proposed to expand the definition of colorectal cancer screening to include a follow-up screening colonoscopy after a positive result on a Medicare covered non-invasive stool-based screening test. CMS believes this would reduce screening barriers by ensuring patients will not be responsible for cost sharing for the additional test.”
However, the proposed policies fail to include any trace of CT colonography for colorectal cancer screening. The ACR notes that “CMS recently responded to the ACR’s formal reconsideration request that there is not sufficient evidence to support changing the current noncoverage determination for CT colonography. The ACR will meet with CMS in the near future to discuss its rationale for the decision.”
These are not all the impacts of the proposed PFS policy. Explore more regulatory, policy, and coding knowledge to master compliance and coding with our monthly Radiology Compliance Manager.
Information Sources:
https://www.acr.org/-/media/ACR/Files/Advocacy/AIA/ACR-Preliminary-Summary-2023-MPFS-PR-FINAL.pdf
That’s how Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz announced the publication of the CMS Final Rule on the Adoption of Standards
We’ve spent the better part of the last decade talking about what artificial intelligence (AI) can do for patients – predicting sepsis, flagging deterioration, and
Please log in to your account to comment on this article.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Stacey Shillito, CDIP, CPMA, CCS, CCS‑P, CPEDC, COPC. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s third quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
BLOOM INTO SAVINGS! Get 25% OFF during our spring sale through March 27. Use code SPRING26 at checkout to claim this offer.
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
