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% |
If you’re seeking assistance with improving your overall RCM processes, contact us today for a free consultation.