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Physician Fee Schedule Final Rule for Calendar Year 2022 – CMS Reduces Rates and Extends Telehealth – Food, Medicines, Healthcare, Life Sciences


United States: Physician Fee Schedule Final Rule for Calendar Year 2022 – CMS Cuts Fees and Expands Telehealth

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On November 2, 2021, the Centers for Medicare and Medicaid Services (“CMS”) Posted its final rule for the Calendar Year (CY) 2022 of the Physician Fee Schedule (“PFS”). In this article, we sample a few highlights of the Final Rule. For more details, see our previous post, in which we highlight the changes made by the PFS to the regulation of the Physician Self-Referral Act (“Stark Law”), and listen to future articles in the series that describe the changes in more detail. made by CMS in its final rule.

Conversion factor. In PFS CY 2022, CMS reduced its conversion factor by approximately 3.75% to account for a budget neutrality adjustment and the expiration of the conversion factor increase that was put in place for account for losses due to COVID-19 during CY 2021. This will result in lower Medicare payment rates on a unit of service basis (while the inflation rate is above 7%) .

Telehealth. CMS has also extended the permitted scope of telehealth services (the “Category 3” services) that it added to the PFS in CY 2020 in response to COVID-19 until the end of 2023. In addition, the new following remote monitoring / therapeutic treatment Management codes (“RTM”) have been added: 98975, 98976, 98977, 98980 and 98981.

Direct billing of physician assistants. Equally important, the MPFS is implementing recent changes in the law to allow physician assistants who provide services under Part B to bill Medicare directly for the services they provide.

Vaccinations. CMS will continue to reimburse $ 40 per dose of COVID-19 vaccine until the end of the calendar year in which the public health emergency ends. To increase access to other vaccines, CMS will also reimburse flu, pneumococcal and hepatitis B vaccines at $ 30 per dose.

Rural health clinics (“CHR”) and federally approved health centers (“FQHC”). CMS will provide reimbursement for mental health visits to RHCs and FQHCs that are provided using real-time interactive telecommunications technology. These visits will be reimbursed at the same rate as in-person visits. Where beneficiaries do not consent to the use of video technology, audio-only tours will also be reimbursed at the same rate. It is important to note that in-person visits should be provided once every 12 months for mental health visits, but exceptions can be made on a case-by-case basis.

Shared Health Insurance Services Program (“MSSP”). CMS will delay the requirement for participating ACOs to meet certain minimum quality performance standards at 40e percentile until fiscal year 2024; the standards will now remain fixed at 30e percentile of program year (“PY”) 2023.

For more details read the full text of the final rule implementing the CY 2022 Physician Fee Schedule here.

Physician Fee Schedule Final Rule for Calendar Year 2022 – CMS Cuts Fees and Expands Telehealth

The content of this article is intended to provide a general guide on the subject. Specialist advice should be sought regarding your particular situation.

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