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UCR 128: How the new law impacts urology reimbursement in 2023; Modifier 25 - "unrelated to the decision to perform procedure" discussion

 January 6, 2023

Mark, Ray, and Scott discuss the new law's impact on urology.   CMS released updated national Medicare physician payment files that incorporate the changes in the Consolidated Appropriations Act of 2023. Specifically, 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.

Also, they have a discussion about the CCI Modifier -25 guidelines:

"If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. In general, E&M services performed on the same date of service as a minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25."


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