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Medicare Physician Fee Schedule 2024: What You Need to Know

Jon-Michial Carter
Written by Jon-Michial Carter

The Medicare Physician Fee Schedule for 2024 has brought significant changes regarding how much practices are reimbursed. CMS originally announced that the conversion factor for payments would be reduced by 3.4%. But with the passage of the Consolidated Appropriations Act in March 2024, that dramatic reduction was lessened by 1.68%.

Still, this is a reduction that is worrying for many practices and hospital systems. The good news is that providers will have more opportunities to receive payments for primary care and some other direct forms of patient care. The new PFS also offers incentives for practices to join ACOs, like the Medicare Shared Savings Program.

Practices that don't want to lose revenue from Medicare E&M reimbursements will need to adjust their 2024 strategy to focus on performing well in value-based programs. Programs like ACO MSSP, Alternative Payment Models, and/or MIPS can help make up for reduced evaluation and management (E&M) encounter revenue.  

Value-based care offerings, like Chronic Care Management (CCM), can help practices improve their quality scores and add Medicare reimbursements they need. 

Changes in Payment Rates

In 2024, providers will see lower overall payment rates from Medicare. CMS calculates Medicare payments based on the resources typically used to furnish the service, including work, practice expense, and malpractice expense. They then apply a conversion factor and geographic adjustments to determine how much they will pay practices. 

The 2024 Physician Fee Schedule conversion factor was $32.74 for January 1-March 8 of 2024. However, with the passage of the Consolidated Appropriations Act, the conversion factor will be $33.29 for March 9-December 31.

This is an improvement for providers, but it is still lower than the 2023 conversion factor of $33.89.

Practices with large numbers of Medicare patients now face the prospect of losing substantial amounts of revenue. Fortunately, CMS also introduced “significant increases in payment for primary care and other kinds of direct patient care.” 

These reimbursement increases primarily come in the form of the new Medicare G code, G2211. This code is for ongoing, longitudinal care for a patient’s chronic conditions and can be added on to evaluation and management (E&M) visits. 

The Physician Fee Schedule and G2211

CMS will officially implement code G2211 in 2024. This add-on code will acknowledge the resource costs associated with evaluation and management (E&M) visits for primary care and longitudinal care. A provider can bill this code when they serve as the patient’s focal point of care, building an ongoing relationship with the patient while also caring for a serious or complex condition. 

The American Academy of Family Physicians estimates that G2211 will result in a payment of $16.05 for each billing in 2024. G2211 can be utilized with CPT Codes 99202-99215.

Medicare has added this code because they recognize that building long-term relationships with patients is part of healthcare and will make the patient more likely to follow their provider’s recommendations. The code recognizes the effort providers put into human connection and designing long-term, comprehensive treatment recommendations. 

By using code G2211, providers can protect or even increase their Medicare reimbursements, while continuing to build relationships with their patients. 

The PFS and Chronic Care Management

Medicare’s continuing commitment to whole-person, preventative care is reflected in their explanation of the rules for CCM consent. The Physician Fee Schedule for 2024 clarifies that practices can obtain consent for CCM in multiple ways (such as over the phone or in person) and that direct supervision by a provider is not needed for consent. 

CCM consent has always been allowed to take place under general supervision. But by explicitly stating this, Medicare establishes that they expect practices to continue employing CCM in 2024 and beyond. Chronic Care Management aligns well with CMS’s current emphasis on preventative, longitudinal care. 

Non-complex CCM gives patients with two or more chronic conditions 20 minutes of preventative care every month. This care is designed to complement and follow up on the care they receive during visits with their provider. 

During CCM calls, patients will work with their personal care coordinators to set care goals that match their provider’s recommendations, track progress toward their goals, and monitor their chronic conditions. 

CCM is also a valuable source of revenue for providers struggling with reductions in payment rates. From March 9-Dec 31, 2024, the national 99490 CCM reimbursement rate will be $62.59 on average (the exact number varies by state.) The national G0511 CCM reimbursement rate will be $74.20 on average (RHCs will consistently receive this payment, while FQHCs vary by state.)

Care coordinators can also connect patients with resources for their SDOH needs. ChartSpan care coordinators help patients locate food pantries or food delivery services, transportation companies, housing agencies, exercise programs, and support groups. 

The Physician Fee Schedule recognizes that social determinants like access to safe housing, healthy food, transportation to appointments, and emotional support are important components of patients’ whole health. Chronic Care Management can help practices focus on these socioeconomic needs and on ongoing care for their patients. 

Medicare Physician Fee Schedule 2024 and MSSP

CMS announced changes to the Medicare Shared Savings Program (MSSP) in the CY 2024 Medicare Physician Fee Schedule. These changes support CMS’ overall plan of growth, alignment and equity.

 These changes continue to build on changes finalized in previous final rules:

  • Changes to the beneficiary assignment methodology
  • Establishing a new collection type for ACOs
  • A CEHRT Requirements alignment with MIPS

Changes to MSSP Beneficiary Attribution

Starting in 2024, CMS will change the beneficiary assignment methodology to provide greater recognition of the role of nurse practitioners, physician assistants, and clinical nurse specialists in delivering primary care. CMS estimates that this change will grow assignable beneficiaries by more than 760,000, which could help MSSP participants receive more payments. 

Completing Annual Wellness Visits and having patients in a Chronic Care Management program can help ensure beneficiaries are attributed to the right provider.

Medicare patients are frequently attributed to the provider who performs their Annual Wellness Visit. If the patient doesn’t have an AWV, they can also be attributed based on plurality of care. Since CCM providers can bill for up to 12 CCM visits per year, patients are likely to be attributed to that provider. 

AWVs, CCM and other value-based care offerings can therefore help solidify beneficiary attribution, a key component of MSSP.

MSSP Medicare Clinical Quality Measures (CQMs)

Shared Savings Program ACOs in the Alternative Payment Model Performance (APM) Pathway have a new collection type for quality measures.  Each quarter, CMS will send the ACO a list of beneficiaries eligible for Medicare Clinical Quality Measures (CQMs). This will help ACOs gather quality data for attributed Medicare beneficiaries throughout the performance year. 

CMS has also announced changes to how quality measures will be evaluated under MSSP. These changes are intended to encourage the use of digital data and to protect ACOs who serve complex populations. They will also bring MIPS and MSSP quality measures into closer alignment.

In 2024, quality data can be reported using the CMS Web Interface measures, electronic Clinical Quality Measures (eCQMs) or MIPS Clinical Quality Measures collection types. Starting in 2025, ACOs will have the ability to report quality data by eCQMs, MIPS CQMs, and/or Medicare CQMs.

Alignment of CEHRT Requirements with MIPS 

A small delay was granted for requirements on reporting the MIPS Promoting Interoperability performance category. Starting in 2025, an ACO participant, ACO provider/supplier, or ACO professional that is a MIPS-eligible clinician must report on the MIPS Promoting Interoperability category and earn a score at the individual, group, virtual group, or APM Entity level. 

The requirement for ACO public reporting related to Certified Electronic Health Record Technology (CEHRT) use was also delayed a year. When this reporting begins, it will help align MIPS and ACO participants. 

Clinical social workers will continue to have automatic reweighting in 2024 for the Promoting Interoperability performance category.  Physical therapists, occupational therapists, qualified speech-language pathologists, clinical psychologists, and registered dietitians or nutrition professionals will not be automatically reweighted starting January 1, 2024.

To work toward this goal of greater MSSP and MIPS alignment, CMS also plans to apply the Shared Savings Program’s health equity adjustment to an ACO’s MIPS Quality performance category score when calculating shared savings payments. ​​This change will help support ACOs that deliver high-quality care to underserved populations. 

MIPS Quality Measures

For providers focused on MIPS, CMS has added five new MIPS Value Pathways (MVPs) for 2024. The five new MVPs providers can choose from are:

  • Focusing on Women’s Health
  • Quality Care for the Treatment of Ear, Nose, and Throat Disorders
  • Prevention and Treatment of Infectious Disorders Including Hepatitis C and HIV
  • Quality Care in Mental Health and Substance Use Disorders
  • Rehabilitative Support for Musculoskeletal Care

 They also modified many of the MVPs from 2023

CCM and Quality Measures

Chronic Care Management has consistently helped practices improve their quality scores for value-based care. CCM coordinators can identify care gaps, like missing vaccinations or screenings, and help patients make appointments with their providers to address those needs. They can also help patients create strategies to manage their A1C levels, blood pressure, and cholesterol. 

CCM is one of the most effective programs for helping practices improve their quality scores. Eligible patients who enrolled in CCM cost Medicare $3,938 less per year than patients who were eligible but didn’t enroll, leading to a 28% reduction in annual costs for Medicare, taxpayers, and patients. This makes CCM valuable for any practice that’s in or plans to join an ACO. 

These changes can help MSSP participants improve their quality scores, so they receive more benefits from the Shared Savings program. In the future, more and more practices will need to move toward a value-based care model where improving quality measures is a priority. 

Preparing for the New Medicare Physician Fee Schedule

Many practices are understandably worried about overall PFS payment rates decreasing in 2024. Fortunately, Medicare has included new ways for practices to earn revenue, from code G2211 for longitudinal care to focusing on quality measures and shared savings.

Although the Physician Fee Schedule changes each year, practices can prepare for these changes by concentrating on whole-person health, quality, and value-based care. If you’d like to learn more about how Chronic Care Management and Annual Wellness Visits can help with quality measures, check out our quality improvement page.

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