Updates

Physician Reimbursement Updates

CMS bumps inpatient hospital payment by 4.3% for 2023

In August, the Centers for Medicare & Medicaid Services CMS issued the fiscal year (FY) 2023 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) final rule.

The increase in operating payment rates for general acute care hospitals paid under the IPPS, that successfully participate in the Hospital IQR Program and are meaningful electronic health record (EHR) users, is 4.3%.

“This reflects a FY 2023 hospital market basket update of 4.1% reduced by a 0.3 percentage point productivity adjustment and increased by a 0.5 percentage point adjustment required by statute,” CMS said in a release. “This update reflects the most recent data available, including a revised outlook regarding the U.S. economy and, as a result, is 1.1 percentage point higher than the proposed update for FY 2023.”

For FY 2023, CMS expects LTCH PPS payments to increase by approximately $71 million. LTCH PPS payments for FY 2023, for discharges paid the LTCH standard payment rate, are expected to increase by approximately 2.3% due primarily to the annual standard federal rate update (that is, the productivity-adjusted market basket increase) for FY 2023 of 3.8% and a projected decrease in high cost outlier payments.

CMS also recently issued a final rule that updates Medicare payment rates for hospice providers.

The FY 2023 hospice payment update percentage is 3.8% (an estimated increase of $825 million in payments from FY 2022). This is a result of the 4.1% market basket percentage increase reduced by a 0.3 percentage point productivity adjustment, CMS said in a release. Hospices that fail to meet quality reporting requirements receive a 2% point reduction to the annual hospice payment update percentage increase for the year.

AMA updates CPT codes for monkeypox testing and vaccination

The American Medical Association (AMA) announced an update to Current Procedural Terminology (CPT)®, the nation’s leading medical terminology code set for describing health

care procedures and services, that includes a new laboratory test code for the orthopoxvirus and two codes for the vaccines being utilized to prevent monkeypox infection.

These new CPT codes are effective for immediate use and are designed to clinically distinguish the diagnostic test and vaccinations for monkeypox to support data-driven tracking, reporting and analysis necessary for resource planning and allocation during the public health response to the outbreak, the AMA said in a release.

“In the wake of the World Health Organization (W.H.O.) declaring monkeypox a global health emergency, and with case numbers increasing in the United States, these CPT updates are timely,” said AMA President Jack Resneck Jr., M.D. “The daily increase in cases in the U.S. shows community spread occurring; however we are relieved to see access to testing has increased to 80,000 specimens per week with commercial labs now online and vaccine supply is increasing. Monkeypox is most often spread person to person through close personal contact, but preventive measures can help you avoid infection. We urge patients to check trusted, evidencebased sources like the CDC and AMA and to contact their physician if they have questions about prevention, diagnosis, or treatment of monkeypox.”

The new laboratory test CPT code (87593) describes molecular diagnostic testing that detects the nucleic signature of an orthopoxvirus, including the monkeypox virus.

The two new vaccine codes are designed to describe the two smallpox and monkeypox virus products currently available.

The first code (90622) describes the existing FDA-approved ACAM2000 vaccine manufactured by Sanofi Pastuer Biologics Co. for active immunization against smallpox disease for persons determined to be at high risk for smallpox infection.

The second code (90611) describes the FDA-approved JYNNEOS vaccine manufactured by Bavarian Nordic for prevention of smallpox and monkeypox disease in adults 18 years of age and older at high risk for smallpox or monkeypox infection.