Released on Nov 4, 2022

2023 Medicare Payment Policies Are Mixed News for GI

The Centers for Medicare and Medicaid Services (CMS) have released final rules for 2023 Medicare payments.

Topline Takeaways

Good news! Full CRC continuum covered in Medicare

  • In a win for patients and thanks to our collective advocacy efforts, CMS expands the regulatory definition of “colorectal cancer screening tests” and waives cost sharing for a necessary follow-up colonoscopy after a positive stool-based screening test.
Bad news: Looming cuts on the horizon, GI societies to take action

  • The rule finalizes more than 4% in mandated Medicare physician reimbursement cuts through decreases in the conversion factor and expiration of temporary fixes passed by Congress. The CY 2023 conversion factor is $33.06, an unacceptable cut for our members. The GI societies continue to work with a coalition of national and state medical societies to urge Congress to prevent these cuts before Jan. 1, 2023.
Good news: ASC + hospital payments on the rise

  • ASC payments and facility fee payments increase 3.8% for institutions that meet quality reporting requirements. The CY 2023 ASC conversion factor is $51.854 and the hospital outpatient conversion factor is $85.585.
  • CMS removed motility codes 91117 and 91122 from APC 5731, where their payments would have been cut 21%, and finalized their placement in APC 5722, where they get a 3% payment increase beginning Jan. 1, 2023. Thank you to the motility community for helping us secure this win.
  • CMS raises the hospital payment for ESD code C9779 to $3,260.69, a $765.65 increase from 2022. We continue to work with CMS on our request for separate codes for lower ESD and upper ESD and payments that better reflect their unique resource costs.

Resources





Read a more detailed summary of the OPPS final rule’s impact to GI practice





About Gastrointestinal Endoscopy
Gastrointestinal endoscopic procedures allow the gastroenterologist to visually inspect the upper gastrointestinal tract (esophagus, stomach and duodenum) and the lower bowel (colon and rectum) through an endoscope, a thin, flexible device with a lighted end and a powerful lens system. Endoscopy has been a major advance in the treatment of gastrointestinal diseases. For example, the use of endoscopes allows the detection of ulcers, cancers, polyps and sites of internal bleeding. Through endoscopy, tissue samples (biopsies) may be obtained, areas of blockage can be opened and active bleeding can be stopped. Polyps in the colon can be removed, which has been shown to prevent colon cancer.

About the American Society for Gastrointestinal Endoscopy
Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence and innovation in gastrointestinal endoscopy. ASGE, with almost 15,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit Asge.org and ValueOfColonoscopy.org for more information and to find a qualified doctor in your area.

 

American Society for Gastrointestinal Endoscopy
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Media Contact

Andrea Lee
Director of Marketing and Communications
630.570.5603
ALee@asge.org