There are some important changes in the Medicare program for 2023, and yet another last-minute cliff-hanger for physician reimbursement.

Q. What are the 2023 changes?

A. 2021 brought changes to how physicians and coders selected codes for outpatient and office-based evaluation and management (E/M) services. These changes shifted the focus from documenting history and exam elements to medical decision making (most visits) or time (rarely). We’re all familiar with this now.

Most ophthalmic exams are coded based on the number and severity of problems (High, Moderate, Low, Minimal), the amount of data reviewed (Extensive, Moderate, Limited, Minimal/None) and the level of management (High, Moderate, Low, Minimal). These determinations correspond to the level of E/M service: 992x5 (High), 992x4 (Moderate), 992x3 (Low) and 992x2 (Straightforward).

In 2023, coding for hospital, nursing home and home services underwent the same type of changes. In addition, many codes were redefined, especially for nursing and home visits. Table 1 shows the coding and levels for hospital visits.

Table 2 includes nursing home and home visits. These codes should also be used to report E/M services provided to a patient in psychiatric residential treatment centers and intermediate care facilities for individuals with intellectual disabilities.

Q. Are there any new codes for ophthalmology?

A. Unlike prior years, ophthalmology did not get a lot of new codes; however, several ophthalmic codes were redefined.

Coding for canaloplasty changed a little to include a specific reference to canaloplasty that was previously omitted:

• 66174 Transluminal dilation of aqueous outflow canal (eg, canaloplasty); without retention of device or stent
• 66175 Transluminal dilation of aqueous outflow canal (eg, canaloplasty); with retention of device or stent

Glaucoma therapy has a NEW Category III code. This was actually effective July 1, 2022, but is now in the CPT book:

• 0730T Trabeculotomy by laser, including optical coherence tomography guidance

Orthoptic training gets one REVISED and one NEW Category I CPT code. There is now a distinction between services performed by a physician or qualified health professional (QHP) vs those performed by staff under supervision:

• 92065 Orthoptic training; performed by a physician or QHP
• 92066 Orthoptic training: under supervision of a physician or QHP

A couple other CPT code revisions:

• 92229 Imaging of retina for detection or monitoring of disease; point of care autonomous analysis and report; unilateral or bilateral
• 92285 Diagnostic dark adaptation examination with interpretation and report

Q. What’s happening with physician reimbursement?

A. The 2023 Medicare Physician Fee Schedule (MPFS) Final Rule was published in early November 2022. The 2023 MPFS conversion factor was $33.06, down 4.6% from $34.6062 in 2022. As in prior years, Congress stepped in and made last-minute changes. These include a 2.5% positive adjustment to the MPFS for 2023, and the 4.0% PAYGO cuts have been delayed 2 years (until 2025). Sequestration reductions of 2.0% are still in effect for 2023. With these changes, the 2023 MPFS conversion factor is now $33.8872, down a total of 2.08% ($0.719) from 2022.

CMS estimated that year-over-year aggregate Medicare payments to ophthalmologists and optometrists would be reduced by 1%, although that varies by procedure code. Most changes are reductions; the only notable increase is to fluorescein angiography (92235), which is up about 9%. For examples of some common codes, see Table 3.

For some ophthalmic surgical procedures, the Final Rule contained noticeable reductions in the Medicare payment rates for 2023 (see Table 4).

For the second consecutive year, strabismus surgery payment rates went down. This year, the cuts range from 6%-21%. Canaloplasty codes are also down (10%-18%), and optic nerve decompression decreased by 9%. OM

Suzanne L. Corcoran, COE, is vice president of Corcoran Consulting Group. She can be reached at (800) 399-6565 or www.corcoranccg.com .