CMS Releases Final Rule for CY 2022 Medicare Physician Fee Schedule


cms-releases-final-rule-for-cy-2022-medicare-physician-fee-scheduleCMS has finalized the calendar year (CY) 2022 Medicare Physician Fee Schedule to promote greater telehealth utilization, boost reimbursement rates for vaccine administration, and improve health equity, among other initiatives, the federal agency said.

The final rule will implement “a series of standard technical proposals” as part of CY 2022 rate-setting, CMS said. The conversion factor for next year will be $33.59, a decrease of $1.30 versus the CY 2021 conversion factor. Next year’s rate accounts for statutory changes to relative value units (RVUs) and the expiration of the 3.75 percent temporary CY 2021 payment increase Congress approved through pandemic-related legislation.

The CY 2022 conversion factor also reflects a statutory update of 0 percent and an adjustment necessary to account for changes in RVUs and expenses that would result from our finalized policies, according to the final rule.

Other finalized policies include the elimination of geographic barriers when it comes to using telehealth for behavioral healthcare. The final rule enables patients to access telehealth services in their homes versus a qualifying healthcare site for diagnosis, evaluation, and treatment of mental health disorders.

“The COVID-19 pandemic has highlighted the gaps in our current health care system and the need for new solutions to bring treatments to patients, wherever they are,” CMS Administrator Chiquita Brooks-LaSure said in an announcement. “This is especially true for people who need behavioral health services, and the improvements we are enacting will give people greater access to telehealth and other care delivery options.”

The Medicare Physician Fee Schedule will pay for mental health visits furnished by rural health clinics and federally qualified health centers using telehealth, including audio-only telephone calls, for the first time outside of the COVID-19 public health emergency (PHE), CMS noted.

The agency also finalized an extension for services added to Medicare’s telehealth list during the COVID-19 PHE until CY 2023. The rule also extended inclusion of some cardiac and intensive cardiac rehabilitation codes on the telehealth list through the end of CY 2023.

Through the CY 2022 Medicare Physician Fee Schedule final rule, CMS will also support another high priority from the COVID-19 PHE: vaccine administration.

The agency finalized in the rule a higher Medicare reimbursement rate for the administration of certain vaccines. The rule states that Medicare will pay $30 per dose for the administration of the influenza, pneumococcal and hepatitis B virus vaccines and will continue to pay $40 per dose for administration of the COVID-19 vaccines.

Medicare reimbursement rates for in-home administration will be $35.50 through the end of the COVID-19 PHE and $450 for administration of COVID-19 monoclonal antibody treatments in healthcare settings. The rate for in-home administration will be $750.

Also finalized in the new rule are new policies regarding split, or shared, evaluation and management (E/M) visits, implementation of new modifiers for physical and occupational therapy services furnished by physical therapist assistants and occupational therapy assistants, and authorization of the direct payment of physician assistants for qualifying services.

To view the complete final rule, click here. Please note that the rule has been filed on the Federal Register but has not yet been published. Stay tuned for more coverage.

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