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2023 Proposed Medicare PFS: See Impact to Pathology

The 2023 Medicare Physician Fee Schedule Proposed Rule was released late Thursday, July 7. After two consecutive years of a Congress delaying a number of anticipated reimbursement cuts due to the impact of the COVID pandemic, it now appears some of these previously planned reductions are back in motion.

The proposed conversion factor is $33.08, a decrease of $1.53 to the 2022 PFS conversion factor of $34.61. According to a press release from CMS, the conversion factor accounts for the statutorily required 0% update for 2023, the expiration of the 3% increase in PFS payments for 2022 as required by the Protecting Medicare and American Farmers from Sequester Cuts Act, and the statutorily required budget neutrality adjustment to account for changes in Relative Value Units.  

Both pathology and independent laboratories are expected to see their overall allowed charges drop by -1%.

Medicare sequestration cuts also fully resumed on July 1, 2022. This budget control mechanism was temporarily suspended during the majority of the public health emergency and partially resumed in April of this year. Since 2013, Medicare has been subject to an automatic annual “sequestration” cut of 2% as required by the Budget Control Act of 2011, which was postponed at the start of the COVID-19 PHE.

Below is a sampling of several popular pathology codes set to see reductions or minor positive adjustments in 2023 as currently proposed:

 

CPT Code Service Final 2022 Proposed 2023 % Change 22-23
80503 (Non-Facility) Path clinical consult sf 5-20 $26.65 $26.46 -0.7%
80504 (Non-Faciltiy) Path clinical consult mod 21-40 $53.29 $51.60 -3.2%
80505 (Non-Facility) Path clinical consult high 41-60 $96.55 $94.28 -2.4%
80506 (Non-Facility) Path clinical consult prolonged svc $43.26 $41.68 -3.7%
88112 – Global Cytopath cell enhance tech $67.48 $66.49 -1.5%
88112 – TC Cytopath cell enhance tech $39.80 $40.03 0.6%
88112 – 26 Cytopath cell enhance tech $27.69 $26.46 -4.4%
88120 – Global Cytp urne 3-5 probes ea spec $630.53 $592.13 -6.1%
88120 – TC Cytp urne 3-5 probes ea spec $572.39 $536.56 -6.3%
88120 – 26 Cytp urne 3-5 probes ea spec $58.14 $55.57 -4.4%
88121 – Global Cytp urine 3-5 probes cmptr $444.00 $415.15 -6.5%
88121 – TC Cytp urine 3-5 probes cmptr $395.90 $369.17 -6.8%
88121 – 26 Cytp urine 3-5 probes cmptr $48.10 $45.98 -4.4%
88184 Flowcytometry/ 1st marker $69.21 $61.20 -11.6%
88185 Flowcytometry/ additional marker $22.15 $18.19 -17.9%
88187 Flowcytometry/read 2-8 $35.99 $33.74 -6.3%
88188 Flowcytometry/read 9-15 $62.98 $60.54 -3.9%
88189 Flowcytometry/ read 16+ $84.44 $81.38 -3.6%
88305 – Global Tissue exam by pathologist $71.98 $70.79 -1.7%
88305 – TC Tissue exam by pathologist $34.61 $34.73 0.3%
88305 – 26 Tissue exam by pathologist $37.38 $36.06 -3.5%
88307 – Global  Level V, tissue exam by pathologist $290.69 $286.80 -1.3%
88307 – TC Level V, tissue exam by pathologist $208.33 $208.40 0.0%
88307 – 26 Level V, tissue exam by pathologist $82.36 $78.40 -4.8%
88309 – Global Tissue exam by pathologist $441.58 $433.35 -1.9%
88309 – TC Tissue exam by pathologist $296.92 $295.40 -0.5%
88309 – 26 Tissue exam by pathologist $144.65 $137.94 -4.6%
88312 – Global Special stains group 1 $114.55 $111.15 -3.0%
88312 – TC Special stains group 1 $88.25 $85.68 -2.9%
88312 – 26 Special stains group 1 $26.30 $25.47 -3.2%
88313 – Global Special stains group 2 $82.36 $81.05 -1.6%
88313 – TC Special stains group 2 $70.25 $69.47 -1.1%
88313 – 26 Special stains group 2 $12.11 $11.59 -4.3%
88341 – Global Immunohistochemistry (add stain) $89.63 $85.02 -5.1%
88341 – TC Immunohistochemistry (add stain) $61.60 $58.55 -5.0%
88341 – 26 Immunohistochemistry (add stain) $28.03 $26.79 -4.4%
88342 – Global Immunohisto antibody 1st stain $102.43 $99.24 -3.1%
88342 – TC Immunohisto antibody 1st stain $67.83 $65.83 -2.9%
88342 – 26 Immunohisto antibody 1st stain $34.61 $33.41 -3.5%
88367 – Global Insitu hybridization auto $114.89 $112.80 -1.8%
88367 – TC Insitu hybridization auto $81.33 $80.72 -0.8%
88367 – 26 Insitu hybridization auto $33.57 $32.09 -4.4%
88368 – Global Insitu hybridization manual $138.08 $141.25 2.3%
88368 – TC Insitu hybridization manual $96.90 $101.22 4.5%
88368 – 26 Insitu hybridization manual $41.18 $40.03 -2.8%
G0416 – Global Prostate biopsy $358.52 $355.94 -0.7%
G0416 – TC Prostate biopsy $180.99 $186.57 3.1%
G0416 – 26 Prostate biopsy $177.53 $169.37 -4.6%
G0452 – Global Molecular path interp $49.14 $48.63 -1.0%
G0452 – TC Molecular path interp $3.12 $2.98 -4.5%
G0452 – 26 Molecular path interp $46.03 $45.65 -0.8%
P3001 Screening pap smear by phys $22.49 $22.49 0.0%
Source: CMS

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