2024 Medicare physician fee schedule reduces conversion factor, but has positives for primary care

The Centers for Medicare and Medicaid Services (CMS) released the final rule on the 2024 Medicare Physician Fee Schedule on Nov. 2.

First, the bad news: CMS reduced the 2024 conversion factor (i.e., the amount Medicare pays per relative value unit) to $32.74, a roughly 3.4% reduction from 2023 ($33.89).

But there’s also good news for primary care, including:

Implementation of G2211. Family physicians and others will be able to report and get paid for this add-on code (which describes visit complexity) with many E/M services. (For more on how this will benefit primary care, see this AAFP explainer. For more on how and when to use code G2211, see this FPM article.)

Congress could intervene to delay the conversion factor cuts or the implementation of G2211, as it has done in past years. If so, this post will be updated. Also, the January/February 2024 issue of FPM will have more on these and other 2024 coding and payment changes. 

Telehealth flexibilities extended. CMS is maintaining multiple telehealth flexibilities through the end of 2024, including:

• No in-person requirement for telehealth services for the diagnosis, evaluation, or treatment of mental health disorders.
• No originating site restrictions.
• No telehealth frequency limitations for inpatient and nursing facility services and critical care consultation services.
• Covering audio-only services on the Telehealth Services List as of Dec. 29, 2022.
• Covering and paying for telephone E/M services (codes 99441-99443).
• Allowing physicians to provide direct supervision through real-time audio and video interactive communications.
• Delaying until Jan. 1, 2025, a proposal that would have required physicians and others who render telehealth services from home to report their home address on enrollment and claims forms.

Advancing health equity. CMS finalized several coding and payment policies intended to advance health equity. These include payment for caregiving services, community health integration services (including care involving community health workers), principal illness navigation services, and social determinants of health risk assessments.

No increase in Merit-based Incentive Payment System (MIPS) performance threshold. The MIPS performance threshold will remain at 75 points for the 2024 performance period (CMS had previously proposed increasing it to 82 points). The lower threshold will make it easier to avoid a negative payment adjustment in 2026.

— Kent Moore, AAFP Senior Manager, Payment Strategies

Posted on Nov. 6, 2023