Medicare Finalizes 2024 Payment and Quality Reporting Changes

The Centers for Medicare & Medicaid Services (CMS) released the final 2024 Medicare Physician Fee Schedule (PFS) rule, which in addition to major payment implications, includes changes to the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) participation options and requirements for 2024. The final rule:

• Sets the 2024 Medicare payment rates for physician services. For 2024, CMS finalized a conversion factor of $32.7442 and $20.4349 for Anesthesia (a decrease of -3.4% and -3.3%, respectively, from final 2023 rates);
• Implements E/M add-on code G2211 and defines the “substantive portion” of a split (or shared) E/M visit to mean more than half of the total time spent by the physician or nonphysician practitioner or a substantive part of the medical decision making;
• Reimburses telehealth services furnished to patients in their homes at the typically higher, non-facility PFS rate;
• Allows direct supervision by a supervising practitioner through real-time audio and video interaction telecommunications through 2024;
• Continues coverage and payment of telehealth services included on the Medicare Telehealth Services List through 2024;
• Pauses implementation and rescinds the Appropriate Use Criteria program regulations;
• Maintains the performance threshold of 75 points for all three MIPS reporting options;
• Adds five new MIPS Value Pathways related to women’s health, prevention and treatment of infectious disease, quality care in mental health/substance use disorder, quality care for ear, nose, and throat, and rehabilitative support for musculoskeletal care;
• Makes numerous changes to the Medicare Shared Savings Program (MSSP) such as revising the MSSP quality performance standard, modifying the program’s benchmarking methodology, and determining beneficiary assignment under the MSSP; and,
• Ends the 3.5% APM Incentive Payment after the 2023 performance year/2025 payment year, and transitions to a Qualifying APM Conversion Factor in the 2024 performance year/2026 payment year.

The calendar year 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 and affordability.

For more detailed information, refer to the PFS fact sheet and the 2024 Quality Payment Program Final Rule Resources within the QPP Resource Library.