AAO-HNS Summary of CY 2024 MPFS Final Rule

Following the Centers for Medicare & Medicaid Services’ (CMS) release of the CY 2024 Final Rule for the Medicare Physician Fee Schedule (MPFS), which also includes proposals related to the Quality Payment Program (QPP), the AAO-HNS prepared a high-level summary of key proposals impacting the specialty.

Conversion Factor

• The finalized CY 2024 Medicare conversion factor is $32.74, a decrease of 3.37% from the CY 2023 MPFS conversion factor of $33.89 (see table below).
• The finalized conversion factor update is primarily based on three factors: 1) a statutory 0% update scheduled for the MPFS in CY 2024; 2) a negative 2.18% budget neutrality adjustment due to final MPFS policies; and 3) a funding patch passed by Congress in December 2022 through the Consolidated Appropriations Act, 2023 (CAA, 2023), which partially mitigated a cut to the CY 2023 CF and offset part of the reduction to the CY 2024 conversion factor.

Estimated Impact to Otolaryngology

• The overall impact of the finalized CY 2024 MPFS is estimated to be 0% for otolaryngology. In the final rule, CMS estimates the impact on total allowable charges by specialty based on three factors: Work RVU Changes, Practice Expense RVU Changes, and Malpractice RVU Changes. For CY 2024, CMS estimates all three categories to have a 0% change and, therefore, an overall change of 0% to the specialty.

Practice Expense RVUs

• CMS finalized updated the Medicare Economic Index (MEI) weights for the different cost components of the MEI for CY 2023. However, CMS postponed implementation of the MEI changes until time uncertain, referencing the need for continued public comment due to the significant impact to physician payments (-7% and PLI payment would be reduced severalfold). For 2024, CMS will continue to postpone implementation of the updated MEI weights, referencing the AMA’s national study to collect representative data on physician practice expenses (the PPI survey). The PPI Survey launched on July 31, 2023, and data will be shared with CMS in early 2025.

Supply Pack Pricing

• CMS indicated their appreciation for the information the RUC Practice Expense Workgroup and others supplied in response to questions about the adequacy of supply pack pricing within the fee schedule, however, they determined that due to significant cost revisions in the pricing of supply packs and the discrepancies in supply pack pricing, this topic would be better addressed in future rulemaking.

Evaluation and Management Visits

G2211 Add-on Code

• CMS finalized a new add-on code for complexity, G2211, which was previously finalized but delayed by Congress until 2024. This add-on code will better recognize the resource costs associated with E/M visits for primary care and longitudinal care. Generally, it will be applicable for outpatient and office visits as an additional payment, recognizing the inherent costs involved when clinicians are the continuing focal point for all needed services, or are part of ongoing care related to a patient’s single, serious condition or a complex condition.

E/M Split or Shared Visits

• Split (or shared) E/M visits refer to visits provided in part by physicians and in part by other nonphysician practitioners in hospitals and other institutional settings. For CY 2024, CMS finalized a revision to their definition of “substantive portion” of a split (or shared) visit to include the revisions to the Current Procedural Terminology (CPT) guidelines, such that for Medicare billing purposes, the “substantive portion” means more than half of the total time spent by the physician or nonphysician practitioner performing the split (or shared) visit, or a substantive part of the medical decision making. This was done in response to comments asking CMS to allow either time or medical decision making to serve as the substantive portion of a split (or shared) visit.

Telehealth

• Due to provisions in the Consolidated Appropriations Act of 2023, CMS finalized continuation of expansion of telehealth practitioners to include speech language pathologists and qualified audiologists. This flexibility will continue through December 31, 2024.

• Again, due to provisions in the Consolidated Appropriations Act of 2023, CMS finalized continuation to provide coverage and payment of telehealth services via an audio-only communications system through December 31, 2024. While the Academy has warned CMS against covering audio-only services at the same rate as in-person services, CMS does not have the authority to alter these flexibilities or make them permanent.

• CMS will continue to define direct supervision to permit the immediate availability of the supervising practitioner through real-time audio and visual interactive telecommunications through December 31, 2024. CMS will consider making this flexibility permanent in possible future rulemaking

• CMS will continue the use of Category 3 Codes for adding services to the Medicare Telehealth Services List (MTSL) on a temporary basis. This category describes services that were added to the (MTSL) during the Public Health Emergency, for which there is likely to be clinical benefit when furnished via telehealth, but there is not yet sufficient evidence available to consider the services for permanent addition under the Category 1 or Category 2 criteria. All requests to add, remove, or change the status of services on the MTSL must be submitted by February 10, 2024.

Valuation of Otolaryngological Services

Posterior Nasal Nerve Ablation (CPT codes 30117, 30118, 3X016, and 3X017)

• In September 2022, the CPT Editorial Panel created two new endoscopy codes for ablation of the posterior nasal nerve: CPT codes 3X016 3X017. During the January 2023 RUC meeting, both new codes, as well as family CPT codes 30117 and 30118, were surveyed. For CY 2024, the RUC recommended a work RVU of 3.91 for 30117, a work RVU of 9.55 for 30118, and a work RVU of 2.70 for both 3X016 and 3X017. CMS finalized, the RUC-recommended work RVUs for three of the four codes surveyed (3X016, 3X017, 30118) however they reduced the value of 30118 to 7.75 RVUs. CMS also finalized their proposed modification to the practice expense inputs for these new codes, slightly reducing the practice expense RVUs for the codes.

Auditory Osseo Integrated Device Services (CPT Codes 926X1 and 926X2)

• For these new CPT codes to report diagnostic analysis, programming and verification of an auditory osseo integrated sound processor, CMS finalized the RUC recommended RVUs of 1.25 for 92622 and 0.33 for code 92623.

Quality Payment Program Updates for CY 2024

Merit-Based Incentive Payment System (MIPS)

• CMS maintained the MIPS performance threshold at 75 points, backing away from its initial proposal to make the program more challenging in 2024 by raising the threshold to 82 points.
• The MIPS category weights did not change for CY 2024 and will remain as follows: Quality 30%, Cost 30%, Promoting Interoperability 25%, and Improvement Activities 15%.

MIPs Value Pathways (MVPs)

• Among the five MIPS Value Pathways (MVPS) finalized this year is “Quality Care for Ear, Nose, and Throat” which was developed by the AAO-HNS and will be particularly useful to the field of otolaryngology. MVPs remain an option for providers to satisfy MIPS requirements. CMS still alludes to the fact that they will eventually sunset the MIPS program but are no longer calling out a specific target date.

Sunset of AUC Program

• CMS finalized their proposal to pause the appropriate use criteria (AUC) program in an effort to reevaluate the process, reserving it for future use. CMS intends to continue the evaluation of the AUC program to identify an appropriate implementation approach.

Data Completeness

• CMS finalized the threshold for data completeness for Medicare CQMs to at least 75% for calendar years 2024, 2025, and 2026.
• CMS finalized a 180-day minimum performance period for the Promoting Interoperability performance category versus the previous 90-day performance period.

Third Party Intermediaries

• CMS finalized policies which will add requirements for third party intermediaries to submit on behalf of eligible clinicians. CMS has also finalized their decision to eliminate the Health IT vendor category.

Public reporting of cost measures

• CMS finalized their proposal to remain current with coding changes related to telehealth by using the most recent codes when the data is refreshed. They affirmed their appreciation of the specialty societies offer to provide feedback in the development of new procedure categories moving forward.