![]() ![]() ![]() These finalized services are aligned with the HHS Social Determinants of Health Action Plan and help implement the Biden-Harris Cancer Moonshot goal of every American with cancer having access to covered patient navigation services. Services Addressing Health-Related Social Needs (Community Health Integration Services, Social Determinants of Health Risk Assessment when done in conjunction with E/M or behavioral health visits, or the Annual Wellness Visit, and Principal Illness Navigation Services)įor CY 2024, CMS is finalizing coding and payment changes to better account for resources involved in furnishing patient-centered care involving a multidisciplinary team of clinical staff and other auxiliary personnel. This action, consistent with the recent Biden-Harris Administration Executive Order on Increasing Access to High Quality Care and Supporting Caregivers, will help support care for persons with Medicare by better training caregivers. Medicare will pay for these services when furnished by a physician or a non-physician practitioner (nurse practitioners, clinical nurse specialists, certified nurse-midwives, physician assistants, and clinical psychologists) or therapist (physical therapist, occupational therapist, or speech language pathologist) as part of the patient’s individualized treatment plan or therapy plan of care. The final CY 2024 PFS conversion factor is $32.74, a decrease of $1.15 (or 3.4%) from the current CY 2023 conversion factor of $33.89.įor CY 2024, CMS is finalizing its proposal to make payment when practitioners train caregivers to support patients with certain diseases or illnesses (e.g., dementia) in carrying out a treatment plan. CMS is also finalizing significant increases in payment for primary care and other kinds of direct patient care. Payment rates are calculated to include an overall payment update specified by statute.ĬY 2024 PFS Ratesetting and Conversion Factorīy factors specified in law, overall payment rates under the PFS will be reduced by 1.25% in CY 2024 compared to CY 2023. Geographic adjusters (geographic practice cost indexes) are also applied to the total RVUs to account for variation in costs by geographic area. These RVUs become payment rates through the application of a conversion factor. Relative value units (RVUs) are applied to each service for work, practice expense, and malpractice expense. ![]() Payments are based on the relative resources typically used to furnish the service. The technical component is frequently billed by suppliers, like independent diagnostic testing facilities and radiation treatment centers, while the professional component is billed by the physician or practitioner. In contrast, PFS rates paid to physicians and other billing practitioners in facility settings, such as a hospital outpatient department (HOPD) or an ASC, reflect only the portion of the resources typically incurred by the practitioner in the course of furnishing the service.įor many diagnostic tests and a limited number of other services under the PFS, separate payment may be made for the professional and technical components of services. Payment is also made to several types of suppliers for technical services, most often in settings for which no institutional payment is made.įor most services furnished in an office setting, Medicare makes payment to physicians and other practitioners at a rate based on the full range of resources involved in furnishing the service. Physicians’ services paid under the PFS are furnished in a variety of settings, including physician offices, hospitals, ambulatory surgical centers (ASCs), skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities,Ĭlinical laboratories, and beneficiaries’ homes. Since 1992, Medicare payment has been made under the PFS for the services of physicians and other billing professionals. The calendar year (CY) 2024 PFS final rule is one of several final rules that reflect a broader Administration-wide strategy to create a more equitable health care system that results in better access to care, quality, affordability, and innovation. On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that announces finalized policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2024. ![]()
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