Washington E-Newsletter

CMS Releases 2024 Medicare Physician Fee Schedule Final Rule

On Nov. 2, the Centers for Medicare & Medicaid Services (CMS) released the 2024 Medicare Physician Fee Schedule Final Rule. The 2024 conversion factor is $32.7442, reduced by 3.37% from the 2023 conversion factor of $33.8872. CMS estimates that neurosurgeons’ overall reimbursement will decrease by one percent in addition to the conversion factor reductions.

Highlights from the final rule include:

  • Split/Shared Billing Changes. CMS finalized a change in its definition of the “substantive portion” of a visit for services furnished in a facility setting by a physician and non-physician practitioner (NPP) from the same group practice. Following an updated and clarified definition published by the American Medical Association Current Procedural Terminology (CPT®) that states the substantive portion of an evaluation and management (E/M) visit is more than half of the total time spent by the physician and NPP performing the split (or shared) visit or a substantive part of the medical decision making (MDM). The AANS and the CNS supported allowing reporting of the visits based on MDM rather than time alone.
  • G2211 Office/Outpatient E/M Visit Complexity Add-On HCPCS Code. Despite objections from the AANS, CNS and other stakeholders, CMS finalized its proposal to activate the G2211 complexity add-on code. Absent Congressional action to halt implementation of this code, it will go live on Jan. 1, 2024. Earlier this fall, the AANS and the CNS had led coalition efforts in the House and Senate advocating that the code is unnecessary and the estimated utilization was too high. This code is mainly responsible for the 2024 Medicare physician payment cut.
  • Code Values for New/Revised Services. CMS accepted the RVS Update Committee-passed values for most of the new neurosurgical codes, including a new code set for skull-mounted cranial neurostimulator codes.

press release and fact sheet provide more information about the final rule.