CMS Releases 2022 Final Medicare Physician Fee Schedule Rule

Alerts / November 9, 2021

On Nov. 2, 2021, the Centers for Medicare & Medicaid Services (CMS) published the Calendar Year (CY) 2022 Medicare Physician Fee Schedule (MPFS) final rule. This final rule will take effect on Jan. 1, 2022, and will include multiple policy changes affecting payments under Medicare Part B. 

Highlights under the CY 2022 MPFS final rule include the following:
  • CY 2022 PFS Conversion Factor. CMS finalized the CY 2022 PFS conversion factor as $33.59, which is a decrease of $1.30 from the CY 2021 PFS conversion factor of $34.89.
  • Split (or Shared) Evaluation and Management (E/M) Visits.
    • CMS finalized an update to the definition of split (or shared) E/M visits as E/M visits provided in the facility setting by a physician and a non-physician practitioner (NPP) in the same group. The visit is billed by the physician or NPP who provides the substantive portion of the visit.
    • By 2023, the substantive portion of the visit will be defined as more than half of the total time spent. For 2022, the substantive portion can be history, physical exam, medical decision-making or more than half of the total time.
    • Documentation in the medical records and a modifier on claims will be required to identify the individuals involved for these services to inform policy and help ensure program integrity.
  • Critical Care Services. CMS finalized refinements to established policies to allow the furnishing of critical care services to the same patient on the same day by more than one practitioner when circumstances require medically necessary critical care services that are not connected to the provision of other care. In such cases, critical care services can be furnished as split (or shared) visits and be paid for the same date of service as other non-critical E/M visits. CMS is implementing a new modifier and documentation requirements to adequately document these situations.
  • Telehealth Services. CMS finalized that certain services added to the Medicare telehealth services list will remain on the Medicare telehealth services list through Dec. 31, 2023, to allow more time for CMS to evaluate whether the services should be permanently added. Additionally, CMS updated its restrictions relating to furnishing mental health telehealth services to reflect the amendments of Section 123 of the Consolidated Appropriations Act of 2021. CMS also amended the current definition of interactive telecommunications system for telehealth services to include audio-only communications technology when used for telehealth services for mental health disorders.
  • Billing for Physician Assistant (PA) Services. Beginning Jan. 1, 2022, PAs can bill Medicare directly.
  • Vaccine Administration Services. CMS will continue to pay the current payment rate of $40 per dose of the COVID-19 vaccine. Also, effective Jan. 1, 2022, CMS will pay $30 per dose of the influenza, pneumococcal and hepatitis B virus vaccines.
  • Rural Health Clinics (RHCs) and Federally Qualified Centers (FQHCs). CMS finalized numerous provisions to increase the capabilities of RHCs and FQHCs to cater to underserved Medicare beneficiaries, such as permitting mental health telehealth visits, making RHCs and FQHCs eligible to receive payment for hospice attending physician services, and permitting concurrent billing for Chronic Care Management Services and Transitional Care Management Services.
  • Reporting Drug Pricing Information for Part B. Drug manufacturers will be required to submit Average Sales Price data for their Part B products for their covered outpatient drugs to be payable under Part B.
  • Clinical Laboratory Fee Schedule: Laboratory Specimen Collection Fee and Travel Allowance. In the Proposed MPFS Rule, CMS solicited comments regarding its policies for nominal specimen collection fees and plans to take the comments into consideration for future rulemaking. CMS also clarified that it will make permanent the option for laboratories to maintain electronic logs of miles traveled for the purposes of covering the transportation and personnel expenses for trained personnel to travel to the location of an individual to collect a specimen sample.
  • Appropriate Use Criteria (AUC). CMS finalized its proposal to begin the payment penalty phase of the AUC program on the later of Jan. 1, 2023, or the Jan. 1 that follows the declared end of the Public Health Emergency for COVID-19, rather than the previous Jan. 1, 2022, date.
  • Medicare Provider Enrollment. CMS finalized its proposals to exempt independent diagnostic testing facilities (IDTF) that only perform services that do not require direct or in-person beneficiary interaction, treatment or testing from several of CMS’ IDTF supplier standards; expand CMS’ authority to deny or revoke a provider’s or supplier’s Medicare enrollment; and establish a rebuttal procedure for those whose Medicare billing privileges were deactivated.
  • Open Payments Financial Transparency Program. CMS made several updates to the program, including the following:
    • Adding a mandatory payment context field for records to teaching hospitals.
    • Adding the option to recertify annually even when no records are being reported.
    • Disallowing record deletions without a substantial reason.

For more information about the CY 2022 MPFS final rule, see the Fact Sheet published by CMS.

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