Impact of 2023 MPFS Proposed Rule on Neurology Billing

2023 Medicare Physician Fee Schedule Proposed Rule

Recently, the Centers for Medicare & Medicaid Services (CMS) released the CY 2023 revisions to payment policies under the Medicare Physician Fee Schedule (MPFS) and other changes to the Medicare part B payment policies (CMS-1770-P) proposed rule. In this article, we shared the impact of the 2023 MPFS proposed rule on neurology billing, the key points are as follows:

Impact of 2023 MPFS Proposed Rule on Neurology Billing

  • CMS shows the impact of the provisions of the rule to be a zero percent chance for neurosurgery. However, CMS proposes a CY 2023 conversion factor (CF) of 33.0775, which is a 4.42 percent (rounded to 4.5%) reduction relative to the CY 2022 CF of 34.6062, which comes in addition to the pending 4% pay-as-you-go cut that congress postponed last year and the resumption of the 2% annual Medicare payment sequester.
  • CMS received a request to designate CPT code 23091 (Allograft, structural, for spine surgery only) as potentially misvalued. CMS has disagreed with the rationale provided by the requester and is proposing not to designate the procedure as misvalued.
  • CMS is considering proposals to rebase and revise the Medicare Economic Index (MEI) cost share weights, and the agency is soliciting comments on this issue. The MEI measures the input prices for providing physician services. The agency proposes a new methodology that allows data to reflect better current market conditions for both ‘physician ownership practices’ and self-employed physicians. It will also enable the MEI to be updated more frequently. The change would not impact the overall MPFS spending but could result in significant changes to payment for particular specialties. CMS is not proposing to use the updated MEI data to set payment rates for CY 2023 but is soliciting comments on future use.
  • According to the analysis of the proposed rule by the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS), the estimated impact on neurosurgery if CMS were to use the proposed rebased and revised MEI cost share weights to adjust the RVUs would be an 8 percent decrease in total allowed charges.
  • CMS is proposing to remove 125 minutes of equipment time for an exam light for spine CPT codes 63020 and 63030 because the RUC contested the typicality of its use to assess the wound and remove staples. However, this is standard equipment in neurosurgical and orthopedic exam rooms.
  • CY 2022 was the final year of a multi-year phased update for practice expense (PE) for supplies and equipment and the first year of a four-year phase-in to update PE clinical labor pricing, as previous data for this component was nearly 20 years old. FY 2023 will be the second of the four years for the phased-in update, and CMS is soliciting comments on any concerns about the implementation process.
  • CMS seeks public comment on strategies for ‘improving’ global surgery code values, continuing to assert that RVUs for these services are inaccurate.
  • As part of the ongoing updates to E&M visits and related coding guidelines, CMS will adopt a substantial portion of the AMA CPT Editorial Panel-approved revised coding and updated guidelines for other E&M visits. This includes inpatient, observation, emergency department, nursing facility, and home/residence service visits.
  • CMS is postponing its proposal for ‘split or shared’ E&M visits, defined as visits provided in a facility by a physician and a non-physician provider in the same group. Last year, CMS implemented a condition that only the practitioner who provides the substantive portion by the time of the visit would be able to bill for the visit. This rule proposes to delay 2024 the change until clinicians who furnish split (or shared) visits will continue to have a choice of history, physical exam, medical decision-making, or time spent to define the substantive portion, instead of using the only total time to determine the substantive portion.
  • As part of an initiative begun in 2021 to sunset outdated National Coverage Determinations (NCDs), CMS has proposed discontinuing the NCD for Ambulatory Electroencephalographic Monitoring and has asked for public comment on the issue.
  • CMS is not proposing to add CPT codes 95976 and 95977 (analysis of cranial nerve neurostimulation) to the Medicare telehealth services list because the full scope of service elements described by these codes cannot currently be furnished via two-way, audio-video communication technology. However, for potential future rulemaking, CMS will consider additional evidence regarding the ability to provide these services via telehealth, such as information indicating that current technology has evolved.
  • CMS proposes to add CPT codes 95970, 95983, and 95984 (general brain nerve neurostimulation) to the Medicare telehealth services list on a Category 3 basis while soliciting comments on concerns regarding patient safety and whether the services are appropriate for inclusion outside the circumstances of the public health emergency (PHE).

Medical Billers and Coders (MBC) is a leading medical billing company providing complete billing and coding services. We referred to an analysis done by the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) to understand the impact of the 2023 MPFS proposed rule on neurology billing. Providers are advised to refer 2023 MPFS proposed rule along with various fact sheets for detailed understanding. If you need assistance in neurology billing and coding, email us at: or call us at 888-357-3226.

Reference: CMS Proposes Physician Payment Rule Expand Access to High-Quality Care

Proposed 2023 Medicare Physician Fee Schedule Rule Summary (American Association of Neurological Surgeons (AANS) Document)