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Final 2024 Medicare fee schedule rule cuts payments and updates policies - will Congress act to avert some of the payment cuts?

Last week, the Centers for Medicare and Medicaid Services (CMS) released its 2024 Medicare Physician Fee Schedule (MPFS) Final Rule. The American College of Radiology and Healthcare Administrative Partners have each released excellent summaries highlighting radiology-specific aspects of the final rule.

The downward march of the MPFS conversion factor will continue to push payments for physician services lower, absent Congressional intervention. The rule sets the conversion factor (CF) a $32.7442, which is 3.37% lower than the $33.8872 CF used for the 2023 fee schedule.

CMS is allowing the HCPCS add-on code G2211 (visit complexity inherent to evaluation and management services) to become active on January 1, 2024.  As we reported earlier, a Congressionally-imposed three-year moratorium on the use of the G2211 code expires at the end of this year. The implementation of this code in CY 2024 is controversial due to its significant impact on other payments because of the application of "budget neutrality" in determining physician fee schedule payments, whereby MPFS payments are based on the number of relative value units (RVUs) performed, multiplied by a conversion factor that is adjusted annually to maintain budget neutrality in the MPFS.  As the add-on code goes active, CMS estimates that G2211 will be responsible for roughly 90% of the proposed budget neutrality reductions in the coming year. In the final rule, CMS appears to be aware of budget neutrality cuts in payments for physicians who will not be using the G2211 code, and they also see the risk of potential overuse of the add-on code by those practitioners who apply the code to their evaluation and management services claims. CMS has attempted clarify when this code should be used and not used. Time will tell how much that advice from CMS is followed.

As expected, CMS is pausing the AUC/CDS program that would deny payment to radiologists and imaging centers when ordering physicians do not utilize a Clinical Decision Support (CDS) mechanism to consult an approved set of criteria to determine the appropriate use (AUC) of a diagnostic test for a Medicare outpatient. Beginning January 1, 2024, CDS/AUC consultation and submission of claims using G-codes and modifiers developed for this program are not required. This program could be resurrected since it was mandated by the Protecting Access to Medicare Act of 2014 (PAMA), but CMS made no comments in the new rule on whether or when that might happen.

And of great significance to radiologists and imaging centers, CMS has revised 42 CFR 410.32(b)(3)(ii) to provide, through December 31, 2024, that “direct” supervision of Level 2 tests (e.g., MRI and CT studies with contrast) can be performed with required presence of the supervising physician (or other practitioner) to occur either physically on site or virtually through audio/video real-time communications technology (excluding audio-only).

Annually, Congress has stepped in to avert deep payment cuts to physicians. The need for such Congressional intervention once again is apparent. Despite the turmoil that appears to rule Congress this year, one can only hope that well-intentioned members of Congress will do the right thing and pass a measure to avert many of the deep cuts in Medicare physician payments. Access to necessary health care in many communities may be jeopardized if they do not act.


The CF calculation includes a 1.25% upward adjustment provided by the Consolidated Appropriations Act, 2023 (CAA 23) that was passed late in 2022 to help mitigate the effects of the formulaic calculation for 2023 and 2024. Without the CAA 23, the 2024 reimbursement rate would have been even lower. Note that the CAA 23 also included deferral until 2025 of the PAYGO rule that would lower the fee schedule by another 4%.


medicare, physician payments, diagnostic radiology, health care & life sciences