Physician Fee Schedule Final Rule for Calendar Year 2022 – CMS Cuts Rates and Extends Telehealth


On November 2, 2021, the Centers for Medicare and Medicaid Services (“CMS”) issued its Calendar Year (CY) 2022 Physician Fee Schedule (“PFS”) Final Rule. In this post, we sample some key highlights from the Final Rule. For more detail, take a look at our previous post, in which we highlight the PFS’s changes to the Physician Self-Referral Law (“Stark Law”) regulations, and stay tuned for future posts in the series further describing the changes made by CMS in its Final Rule.

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

Telehealth. CMS also extended the permissible breadth of telehealth services (the “Category 3” services) that it had added to the PFS in CY 2020 in response to COVID-19 through the end of 2023.  In addition, the following new Remote Therapeutic Monitoring/Treatment Management (“RTM”) codes were added: 98975, 98976, 98977, 98980, and 98981.

Direct Physician Assistant Billing. Also of significance, the MPFS implements recent changes in law to permit physician assistants who furnish services under Part B to bill Medicare directly for services they provide.

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

Rural Health Clinics (“RHCs”) and Federally Qualified Health Centers (“FQHCs”). CMS will allow reimbursement for mental health visits at RHCs and FQHCs that are furnished using interactive, real-time telecommunications technology. These visits will be reimbursed at the same rate as in-person visits. When beneficiaries do not consent to the use of video technology, audio-only visits will be reimbursed at the same rate, as well. Importantly, in-person visits must be furnished once every 12 months for mental health visits, but exceptions may be made on a case-by-case basis.

Medicare Shared Services Program (“MSSP”). CMS will delay the requirement for participating ACOs to meet certain minimum quality performance standards at the 40th percentile until PY 2024; standards will now remain frozen at the 30th percentile in Program Year (“PY”) 2023.

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