Medicare Fee Schedule Changes In 2023
                     Medicar
e Fee 
Schedul
e 
Change
s In 
2023
INTRODUCTION
❏ The internet is ringing with the news of the 
CMS Updates Final rule for the 2023 
Medicare Physician Fee Schedule. 
❏ The finalized 
2023 Medicare Physician Fee Schedule was 
announced by the Centers for Medicare & 
Medicaid Services (CMS) on November 1 
2022. 
❏ The 2023 MPFS features a decrease in the 
fee schedule conversion factor from 
$34.6062 to $33.0607, reflecting in part the 
expiration of the temporary 3% 
supplementary increase in fee schedule 
https://www.medisysdata.com/?utm_source=social&utm_medium=blog&utm_cam
paign=Mpedaisyymsmet nts for CY 2022, among other 
significant modifications outlined by CMS.
Principles of PFS
● On November 1, 2022, the Physician Fee Schedule final 
regulations were published, and they will take effect on 
January 1, 2023.
● Depending on the type of service and the location of the 
treatment, the PFS informs payers (insurance companies 
and patients) of the appropriate payment to be made for 
physicians’ services. As a result, adjustments to the PFS 
over time may cause a physician’s final payment for the 
same service to change.
● The conversion factor is one of the key elements of PFS. 
This is determined by multiplying the actual fees paid for a 
service or treatment by the Relative Value Unit (RVU). It 
seems sense that the physician’s share of the payment 
would be higher the higher the conversion factor.
● These and other acts that affect physicians and other 
healthcare workers will be closely watched by us. If you 
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have any inquiries regarding the Final Rule, please get in 
contact with your DLA Piper relationship partner, the 
authors of this notice, or any other member of our 
healthcare sector group.
Effects of the PFS in 2023 
on providers
● Many medical associations have begun to express their 
dissatisfaction with the final guidelines for the 
2023 Physician Fee Schedule. These organizations contend 
that the reduction in the conversion factor will increase 
financial pressure on doctors, put medical professionals 
against one another, and heighten competitiveness.
● Additionally, these groups note that this loss would come 
on top of the 4% PAYGO sequestration and could result in a 
further decline in revenue in group practices when federal 
spending exceeds a predetermined amount.
● Physicians and other healthcare professionals are 
concerned that this move could cause financial instability, 
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those in need. We must wait to see how this will actually 
impact the financial picture.
Patient effects of the 2023 
PFS
● The Physician Fee Schedule final rules for 2023 include a lot 
of advantages for patients.
● The impact on behavioral health is the main issue to be 
covered. Because the treatments might not be reimbursed 
and the out-of-pocket costs might be high, a sizable 
segment of the population is reluctant to seek help from 
behavioral health specialists.
● However, many behavioral difficulties today emerge as 
physical concerns, and unless the latter are resolved, the 
former won’t be either.
● The 2023 PFS rules, which contain solutions for behavioral 
health, mental health, and physical health, may help provide 
patients with holistic healthcare services.
● When it comes to insurance inclusions, the term “pain care” 
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therapy will now be aided by higher payment rates for 
opioid-based treatments.
● Patients can look forward to CMS continuing to pay for 
extended telehealth services even after the Public Health 
Emergency has expired.
A glance at other 
factors
1. Reduction in the conversion factor and payment
The conversion factor was reduced by $1.55 in the 2023 PFS, 
resulting in a CY 2023 conversion factor of $33.06. This conversion 
factor also takes into account the expiration of the Protecting 
Medicare and American Farmers from Sequester Cuts Act’s 
temporary, offsetting 3% increase in payments for CY 2022 as well 
as the statutorily required budget neutrality adjustment to take into 
account changes in payment rates.
2. Changes in RUC value for ophthalmic operations
The RUC-recommended practice expense and work values for the 
orthoptics CPT code 92065 as well as the RUC-recommended 
practice expense and work values for the anterior segment imaging 
CPT code 99287 were both accepted by the CMS.
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A glance at other 
factors
3. Cataract surgery performed in an office
The CMS said in its proposed rule that it had received requests to 
establish non-facility values for the vitrectomy and cataract surgery 
codes because it had been indicated that these procedures may be 
carried out in an office setting outside of a facility in a safe and efficient 
manner. Before moving forward with a value, the AOA urged CMS to 
assess outcomes information on the effectiveness of surgeries in this 
situation.
The CMS decided to further analyze these services before establishing 
any values after expressing reservations about them in the final rule.
4. Techniques for raising the value of surgical packages globally
The AOA urged a continued reliance on the RUC process in the CMS’ 
proposed rule when determining how many pre- and post-surgery visits 
should be included in a surgical package. The AOA stated that CMS 
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Workgroup’s work, which identifies services with global periods that may 
be undervalued. Furthermore, the AOA noted that such efforts would be 
better spent evaluating particular codes of concern as opposed to 
making generalizations about the global surgery packages as a whole.
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