ADVOCACY ALERT: CMS Releases 2024 Physician Fee Schedule and Hospital Outpatient Prospective Payment System Proposed Rules

The Centers for Medicare & Medicaid Services (CMS) released the 2024 Medicare Physician Fee Schedule (MPFS) and the Hospital Outpatient Prospective Payment System (HOPPS) proposed rules. In the days ahead, your advocacy team will analyze the rules and report to you on specifics that may impact your practice as well as any actions ASNC will take. Here is top-line analysis of a few key proposals:

Medicare Physician Fee Schedule Conversion Factor

CMS's proposed conversion factor for CY2024 is $32.7476. This takes into account the statutorily required update to the conversion factor for CY2024 of 0 percent and the 1.25 percent positive payment adjustment made by Congress. The positive adjustment, however, is not enough to offset the 2.17 percent cut triggered by requirements of budget neutrality resulting in a net reduction. This conversion factor represents a decrease of 3.36 percent from the CY2023 MPFS conversion factor of $33.8872.


Medicare Appropriate Use Criteria Program

CMS has proposed to pause the Appropriate Use Criteria (AUC) Program for advanced diagnostic imaging and to rescind the AUC Program regulations issued to date. This would effectively end the program's “educational and operational testing period.”

CMS states in the proposed rule that the pause will facilitate a “thorough program re-evaluation” and that the Agency is not proposing a timeframe within which implementation efforts may recommence. CMS writes in the rule that its proposal to pause the program is based on the “inherent risks in terms of data integrity and accuracy, beneficiary access, and potential beneficiary financial liability for advanced diagnostic imaging services," which render the AUC Program "impracticable."


Hospital Outpatient Update

CMS proposes an update to HOPPS payment rates by 2.8 percent. This is based on the projected hospital market basket increase of 3.0 percent reduced by 0.2 percentage point for the productivity adjustment.


Packaging for Diagnostic Radiopharmaceuticals

CMS is seeking comment from stakeholders on how the current policy of packaging diagnostic radiopharmaceuticals into the imaging procedure impacts beneficiary access and whether there are specific patient populations or disease states for which the issue of access is especially critical.

CMS asks for stakeholder feedback on new approaches that may enhance beneficiary access while maintaining the principles of HOPPS payment. Specifically, CMS requests feedback on –
  • Paying for diagnostic radiopharmaceuticals with per-day costs above the HOPPS drug-packaging threshold of $140;
  • Establishing a per-day cost threshold that may be greater or less than the HOPPS drug-packaging threshold; and
  • Restructuring ambulatory payment classifications, creating specific payment policy for diagnostic radiopharmaceuticals used in clinical trials or adopting codes that incorporate the disease state being diagnosed. 


Details to Come

ASNC will comment in response to these and other proposals. Please refer to the following documents: 
ASNC's advocacy team is, as always, working for you and will keep you informed.