2022 MPFS Proposed Rule Summary

2022 MPFS proposed rule summary
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By: Barbara Rubel, MBA, FRBMA, Sr. VP, Marketing and Client Services
July 14, 2021

The 2022 MPFS Proposed Rule was released on July 13th, 2021 and below is a quick summary of the key provisions. 

Appropriate Use Criteria & Clinical Decision Support

The Centers for Medicare and Medicaid Services (CMS) proposes to begin the payment penalty phase on the later of January 1, 2023, or the January 1 that follows the declared end of the Public Health Emergency (PHE) for COVID-19.  This flexible effective date is intended to consider the PHE’s impact on providers & beneficiaries.  Currently, the payment penalty phase is set to begin January 1, 2022. 

CMS is also seeking comment on applying the program to secondary Medicare claims.s.

Evaluation & Management Visits

CMS proposes to refine policies for split (shared) E/M visits to:

  • better reflect current practice
  • recognize evolving role of non-physician practitioners
  • clarify the conditions of payment that must be met in order to be paid. 

A split (shared) E/M visit is defined as an E/M visit that is provided in the facility setting by a physician & an NPP in the same group.  The provider who provides the substantive portion of the visit (more than half the total time spent) would bill for the visit and this is the provider who must sign and date the medical record.

Billing for PAs

CMS is proposing to implement section 403 of Division CC of the Consolidated Appropriations Act of 2021 which authorizes Medicare to make direct payment to PAs for professional services they furnish under Part B beginning January 1, 2022. 

Currently, Medicare can only make payment to the employer OR an independent contractor of a PA.  Consequently, PAs cannot bill and be paid directly by the Medicare program for their professional services.  They also do not have the option to reassign payment for their services or to incorporate with other PAs to bill the program for their services. 

If approved, beginning January 1, 2022 PAs would be able to bill Medicare directly for their services and to reassign payment for their services.

Telehealth Services

Category 1 and Category 2 Services:

CMS received several requests to permanently add to the Medicare telehealth services list effective for CY 2022. However, CMS determined that none of the services that were submitted/received by the February 10th deadline met the criteria for Category 1 or Category 2 services for permanent addition to this list.

Category 3 Services:

The CY 2021 MPFS Final Rule created a 3rd category of criteria for adding services to the telehealth services list on a temporary basis because of COVID-19. 

Category 3 telehealth services include services CMS believes are likely to provide clinical benefit when furnished via telehealth, but there is not sufficient evidence to be Category 1 or 2. 

Services on the Category 3 telehealth list will be temporary and remain on the telehealth services list through the end of the calendar year in which the COVID-19 PHE ends.  Because of stakeholder concerns, including uncertainty of when the PHE will end, CMS proposes to retain all services added on a Category 3 basis until the end of CY 2023.  

CMS is also soliciting comment on whether any services added to the Medicare telehealth list for the duration of the PHE for COVID-19 should now be added to the Medicare telehealth list on a Category 3 basis.

Other Provisions

  • CMS accepted an increased value for needle biopsy of lymph nodes and approved values for the new, trabecular bone score code family.

    • No radiology codes are identified as potentially misvalued.

  • Positron Emission Tomography (PET)

    • CMS is proposing to remove the NCD for (PET) scans (NCD 220.6).  This would defer coverage decisions to local Medicare Administrative Contractors. CMS believes allowing local contractors the discretion to consider coverage would allow Medicare beneficiaries greater access to PET scans for non-oncologic indications.

  • Virtual Direct Supervision through Real-Time Audio/Video Technology

    • CMS is seeking comment on whether the flexibility to meet the “immediately available” requirement for direct supervision should be made permanent. This flexibility is currently being used during the PHE and CMS is questioning if providers are expecting to rely on this flexibility after the PHE ends.

Conversion Factor

$33.58 (a 3.75% decrease from $34.89 in 2021)

Estimated Impact:

Per Column F of Table 123 in the Proposed Rule (page 1183), the estimated CY 2022 impact on total allowed charges, by specialty, includes all the RVU changes. It does not, however, include the -3.75% in the conversion factor.

2022 MPFS estimated impact chart

The estimated impact of all the changes is presented below:

2022 MPFS estimated impact all changes

Estimated Decreases also include:

  • Effects of CMS’ proposed clinical labor pricing update.
  • Phase-in implementation of previously finalized updates to supply & equipment pricing.
  • Expiration of the 3.75% payment increase provided in the Consolidated Appropriations Act, 2021 (P.L.116- 260).
Barbara Rubel MBA, FRBMA Senior Vice President, Marketing & Client Services

Barbara Rubel MBA, FRBMA Senior Vice President, Marketing & Client Services

Barbara has been a leader with MSN Client Services since 1998. Her extensive background in strategic planning, market research, healthcare marketing and managed care negotiations provides a wealth of information to support MSN Clients.

Barbara has also been highly involved in industry organizations, serving as President of the Radiology Business Management Association (RBMA), the Georgia RBMA, and the Florida RBMA. In addition, she chaired the influential RBMA Federal Affairs Committee and the RBMA Technology Task force and was a member of the RBMA Data Committee. Her work on behalf of radiology has earned her the RBMA Special Recognition Award (2010), the RBMA Global Achievement Award (2013), and she is a Fellow of the RBMA.