Consolidated Appropriations Act Update

As you probably heard, Congress passed the Consolidated Appropriations Act (CAA) 2023, on December 23, 2022. 

The key components for anesthesia practices include:

• Reset in the Pay-As-You-Go cuts until 2025
• Additional funding for the CMS fee schedule reduced the anesthesia conversion factor to approximately $21.1249 (a 2.03% reduction from the 2022 conversion factor), 
• Extended the Advanced Alternative Payment Plan Model bonus payment through 2023 but reduced to 3.5%, 
• Medicare sequestration is extended through the first 6 months of 2032. The sequester amounts for 2030 and 2031 were raised to 2%. CMS has not published the revised fee schedule yet, but it should be published soon.

Cigna has begun notifying groups of their new anesthesia reimbursement policy (R39) that will be effective March 12, 2023. They will require medical direction modifiers. Claims with multiple CPT codes will only reimburse the CPT code with the highest base units, or the first code if the base units are the same, and the QZ reimbursement will be reduced by 15%. Both items may have a negative impact on your reimbursement in 2023. We will keep you updated as we learn more. 

The Federal Independent Dispute Resolution (IDR) process published guidance for 2023, increasing the 2023 administrative fee that disputing parties must pay to participate in the Federal IDR process to $350 per party. Additionally, the updated 2023 IDR entities’ fee submissions range from $200 to $700 for single determinations and from $268 to $938 for batched determinations. The updated list can be found here.

Hopefully, the news in 2023 will get better!

ACE Expert
Lynette Peterson, CHC, CHA
aceadmin@aceauditors.com