With a new year, there are several new laws and regulations now impacting pathologists and their practices. Below is a recap of what changes you should know for 2023.

New Digital Pathology Codes

The CAP worked with the American Medical Association (AMA) CPT Editorial Panel to establish 13 new digital pathology add-on codes. The new codes are intended to capture and report additional clinical staff work and service requirements associated with digitizing glass microscope slides for primary diagnosis. Digitization of glass microscope slides enables remote examination by the pathologist and/or in conjunction with the use of artificial intelligence (AI) algorithms. As a result of CAP advocacy, the new codes will help pathologists, pathology practices, and laboratories providing digital pathology digitization procedures appropriately report these services. The new digital pathology codes have been effective since January 1, 2023.

Medicare Cuts Mitigated for 2023

The CAP and the physician groups lobbied lawmakers to prevent the entire 4.5% Medicare cut stemming from the program’s policy to increase payment for evaluation and management services. Congress opted to mitigate the cut by 2.5 percentage points in 2023. As a result, the CAP estimates that the average Medicare spending impact on pathology will be a -1.16%.

The Centers for Medicare and Medicaid Services (CMS) released its updated national Medicare physician payment files that incorporate the changes in the Consolidated Appropriations Act of 2023. Specifically, in response to concerted advocacy by organized medicine, Congress reduced the 4.5% cut to Medicare physician payment by increasing the 2023 conversion factor by 2.5%. The updated 2023 Medicare physician payment schedule conversion factor will be $33.8872. The previously finalized conversion factor was $33.0607. The 2022 conversion factor was $34.6062.

Download our 2023 Medicare Physician Fee Schedule impact table showing these changes.

CMS Delayed Enforcement of GFE Requirements

Earlier in December 2022, the CMS announced it delayed the enforcement of the good faith estimate (GFE) requirements for uninsured and self-pay individuals. The CMS released a FAQ stating that the Department of Health and Human Services (HHS) extended enforcement discretion, pending future rulemaking, for situations where GFEs for uninsured (or self-pay) individuals do not include expected charges from co-providers or co-facilities.

The GFE requirements were included in the No Surprises Act and intended to protect uninsured (or self-pay) individuals from unexpectedly high medical bills.