CMS releases physician fee schedule final rule for CY 2024

NCPA November 20, 2023

CMS issued its final physician fee schedule for CY 2024. NCPA had submitted comments to the proposed rule back in September. CMS finalized its proposals to maintain the in-home additional payment for COVID–19 vaccine administration under the Part B preventive vaccine benefit. In addition, CMS finalized its proposal to extend the additional payment to the administration of the other three preventive vaccines included in the Part B preventive vaccine benefit: the pneumococcal, influenza, and hepatitis B vaccines. NCPA was supportive of these policies in its comments. CMS also clarified that for purposes of telehealth, only physicians and nonphysician practitioners qualify as distant site practitioners, so that does not include pharmacies. CMS also clarified that DSMT programs must qualify as a certified provider in accordance with the statute before they can bill for DSMT services. CMS finalized its proposal to extend specific Medicare Diabetes Prevention Program (MDPP) flexibilities allowed during the PHE for COVID–19 1135 waiver events by four years. It also finalized its proposal to exercise its authority in section 1861(hhh)(2)(I) of the Social Security Act to add elements to the Annual Wellness Visit (AWV) by adding a new Social Determinants of Health (SDOH) Risk Assessment as an optional, additional element (with an additional payment.) NCPA had supported both these in its comments to the proposed rule. Finally, CMS stated that NCPA’s request to implement policy changes to leverage pharmacists to deliver clinical services for patients with an opioid use disorder, and other comments that voiced support for legislation that would allow pharmacists to bill for vaccine administration under Medicare Part B, were outside the scope of the proposed (now final) rule.

For more information, see CMS’ final rule, press release, fact sheet and a second fact sheet.