2023 Proposed Medicare PFS: See Impact to Pathology

July 11, 2022

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. If you have questions about any unlisted codes, don’t hesitate to contact us directly:

CPT CodeServiceFinal 2022Proposed 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 – GlobalCytopath cell enhance tech$67.48$66.49-1.5%
88112 – TCCytopath cell enhance tech$39.80$40.030.6%
88112 – 26Cytopath cell enhance tech$27.69$26.46-4.4%
88120 – GlobalCytp urne 3-5 probes ea spec$630.53$592.13-6.1%
88120 – TCCytp urne 3-5 probes ea spec$572.39$536.56-6.3%
88120 – 26Cytp urne 3-5 probes ea spec$58.14$55.57-4.4%
88121 – GlobalCytp urine 3-5 probes cmptr$444.00$415.15-6.5%
88121 – TCCytp urine 3-5 probes cmptr$395.90$369.17-6.8%
88121 – 26Cytp urine 3-5 probes cmptr$48.10$45.98-4.4%
88184Flowcytometry/ 1st marker$69.21$61.20-11.6%
88185Flowcytometry/ additional marker$22.15$18.19-17.9%
88187Flowcytometry/read 2-8$35.99$33.74-6.3%
88188Flowcytometry/read 9-15$62.98$60.54-3.9%
88189Flowcytometry/ read 16+$84.44$81.38-3.6%
88305 – GlobalTissue exam by pathologist$71.98$70.79-1.7%
88305 – TCTissue exam by pathologist$34.61$34.730.3%
88305 – 26Tissue exam by pathologist$37.38$36.06-3.5%
88307 – Global Level V, tissue exam by pathologist$290.69$286.80-1.3%
88307 – TCLevel V, tissue exam by pathologist$208.33$208.400.0%
88307 – 26Level V, tissue exam by pathologist$82.36$78.40-4.8%
88309 – GlobalTissue exam by pathologist$441.58$433.35-1.9%
88309 – TCTissue exam by pathologist$296.92$295.40-0.5%
88309 – 26Tissue exam by pathologist$144.65$137.94-4.6%
88312 – GlobalSpecial stains group 1$114.55$111.15-3.0%
88312 – TCSpecial stains group 1$88.25$85.68-2.9%
88312 – 26Special stains group 1$26.30$25.47-3.2%
88313 – GlobalSpecial stains group 2$82.36$81.05-1.6%
88313 – TCSpecial stains group 2$70.25$69.47-1.1%
88313 – 26Special stains group 2$12.11$11.59-4.3%
88341 – GlobalImmunohistochemistry (add stain)$89.63$85.02-5.1%
88341 – TCImmunohistochemistry (add stain)$61.60$58.55-5.0%
88341 – 26Immunohistochemistry (add stain)$28.03$26.79-4.4%
88342 – GlobalImmunohisto antibody 1st stain$102.43$99.24-3.1%
88342 – TCImmunohisto antibody 1st stain$67.83$65.83-2.9%
88342 – 26Immunohisto antibody 1st stain$34.61$33.41-3.5%
88367 – GlobalInsitu hybridization auto$114.89$112.80-1.8%
88367 – TCInsitu hybridization auto$81.33$80.72-0.8%
88367 – 26Insitu hybridization auto$33.57$32.09-4.4%
88368 – GlobalInsitu hybridization manual$138.08$141.252.3%
88368 – TCInsitu hybridization manual$96.90$101.224.5%
88368 – 26Insitu hybridization manual$41.18$40.03-2.8%
G0416 – GlobalProstate biopsy$358.52$355.94-0.7%
G0416 – TCProstate biopsy$180.99$186.573.1%
G0416 – 26Prostate biopsy$177.53$169.37-4.6%
G0452 – GlobalMolecular path interp$49.14$48.63-1.0%
G0452 – TCMolecular path interp$3.12$2.98-4.5%
G0452 – 26Molecular path interp$46.03$45.65-0.8%
P3001Screening pap smear by phys$22.49$22.490.0%
Source: CMS

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