Medicare 2023 Proposed OPPS and ASC Payment Policies Released

On July 15, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2023 Medicare Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Proposed Rule.

Topline Takeaways:

• Slight Increase in Facility Fees Payments: The proposed CY 2023 Medicare conversion factor for outpatient hospital departments is $86.785, an increase of 2.7%, for hospitals that meet applicable quality reporting requirements. 
• Slight Increase in ASC Payments: The proposed CY 2023 ASC conversion factor is $51.315, an increase of 2.7%, for ASCs that meet applicable quality reporting requirements. The GI societies continue to urge CMS to reduce this gap in the ASC facility fees when compared to the outpatient hospital facility rates, which are estimated to be a roughly 50% differential in CY 2023. 
• 18% cuts to some motility and G-tube codes: Hospital outpatient facility payments for motility codes 91117 and 91122 and G-tube codes 43261-43263 could decrease by 18% due to proposed changes to their Ambulatory Payment Classification (APC) family. 
  

Outpatient Prospective Payment and Ambulatory Surgical Center Payment System Payment Charts

• CY 2023 Proposed Rule ASC Payment Rates
• CY 2023 Proposed Rule ASC Top 10 Base and Biopsy Codes
• CY 2023 Proposed Rule HOPD Payments
• CY 2023 Proposed Rule HOPD Top 10 Base and Biopsy Codes

To find out more about the proposed rule, read the GI societies’ summary. 

CMS OPPS/ASC Proposed Rules and Fact Sheets

CY 2023 OPPS/ASC Payment System Proposed Rule

CY 2023 OPPS/ASC Payment System Proposed Rule Fact Sheet

Medicare Physician Fee Schedule (MPFS) Proposed Rule

On July 7, CMS released the calendar year (CY) 2023 Medicare Physician Fee Schedule (MPFS) proposed rule. Read the GI societies’ summary on the impact to our members and patients.