What to expect in GI with 2023 CMS Physician Fee Schedule: Medscape

Medicare will expand its coverage of colorectal cancer testing with its 2023 physician payment rule along with budget cuts, which comes with benefits and disadvantages, Medscape reported Nov. 21. 

The new rule will lower the minimum age for screening from 50 to 45 years old. It will also eliminate copays for any colonoscopies following a positive stool-based colon cancer test. 

The Digestive Health Physicians Association said in a September comment letter regarding the new rule that getting rid of these copays, despite having more colonoscopies, will save the federal government money due to earlier detection of cancers. 

However, the DHPA took issue with Medicare's support for stool sample tests over colonoscopies in the new rule, citing that the support is based off of a study from 2000 that was not based on Medicare patients and featured only asymptomatic patients. 

"Screening colonoscopy is the right first line screening option for a significant portion of Medicare-age patients and is the only CRC test option that screens, detects, treats, cures and prevents colorectal cancer," DHPA said in its letter.

CMS responded to complaints of its alleged preference in its final rule and said it has not changed coverage for colonoscopies as an optional first step in CRC screening. 

"We recognized there are several advantages to choosing a non-invasive stool-based CRC screening test as a first step compared to a screening colonoscopy, including relative ease of administering the test and potentially reducing the experience of unnecessary burdensome preparation and invasive procedure," CMS said in its final rule. 

The new rule also includes several new federally mandated budget cuts, including a reduction in the physician payment conversion factor, which will fall from $34.61 to $33.06 in 2023. 

Physicians are expected to face a 4.42 percent decrease in Medicare payments with the new system, according to Medscape.

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