The Centers for Medicare and Medicaid Services (CMS) recently released the Physician Fee Schedule (PFS) Final Rule for 2022.
The PFS sets the rates that Medicare pays for physician services and establishes policies for the Medicare program. Here are some key changes and updates from the final rule that providers need to be aware of:
Payment rates
Under the final rule, the conversion factor used to calculate Medicare payment rates will be $33.58 in 2022, a decrease from the 2021 conversion factor of $34.89. This decrease is due to budget neutrality adjustments required by law. The decrease in the conversion factor will result in lower payment rates for many services.
Telehealth
CMS has made several changes to telehealth policies in the final rule. For one, CMS has added several services to the Medicare telehealth list, including group psychotherapy, physical and occupational therapy evaluations, and emergency department visits. CMS has also extended certain telehealth flexibilities that were put in place during the COVID-19 public health emergency. These flexibilities include the ability to provide telehealth services to patients in their homes and the ability to use audio-only telehealth for certain services.
Quality Payment Program
The final rule includes updates to the Quality Payment Program (QPP), which is the program that Medicare uses to pay physicians based on quality and performance measures. CMS has increased the performance threshold for the Merit-based Incentive Payment System (MIPS) to 60 points, up from 45 points in 2021. CMS has also updated the MIPS Cost performance category to include two new episode-based cost measures.
E/M services
CMS has made several changes to Evaluation and Management (E/M) services in the final rule. For one, CMS has increased the work relative value units (RVUs) for certain office/outpatient E/M services. CMS has also revised the guidelines for medical decision-making (MDM) to reduce documentation requirements for certain types of visits. Additionally, CMS has established new add-on codes for prolonged E/M services that extend beyond the typical time for a given level of service.
Payment for COVID-19 vaccines
CMS has finalized its policy on payment rates for COVID-19 vaccines. Medicare will pay $40 for a single-dose vaccine or the first dose of a multi-dose vaccine, and $40 for each additional dose in a multi-dose series. These payment rates apply to vaccines administered in a physician's office, hospital outpatient department, or other approved setting.
Imaging services
CMS has made changes to the payment rates for certain imaging services. In particular, CMS has reduced the technical component (TC) payment rates for certain advanced diagnostic imaging services, including computed tomography (CT) scans and magnetic resonance imaging (MRI) scans. CMS has also revised the professional component (PC) payment rates for certain imaging services to better align with changes in RVUs.