CMS has now released its proposed changes to the Physician Fee Schedule for 2022. Their proposal contains numerous alterations and amendments to current rules, ranging from updates to the payment rate for physician services to the expansion of select Medicare telehealth provisions — an area that has grown considerably owing to lockdowns and an overall trend toward distanced medical care seen across the market.

In this piece, we’re going to quickly run down the 2022 Proposed Medicare Professional Fee Schedule, detailing the changes that will affect the market once it has been implemented and what this may mean for the industry as a whole.

First, there will be an update to the payment rate. There has been an increase in value of some outpatient codes, leading to the Physician Fee Schedule conversion factor going down — from $34.89 in 2021 to a projected $33.58 in 2022. Additionally, by 2022, the 3.75% payment increase created by the Consolidated Appropriations Act of 2021 will have expired.

Moving on, CMS previously said that the payment penalty phase of the AUC program would begin on January 1, 2022. The new proposal delays this until January 1, 2023 — a date they also mark as the proposed end to COVID-19’s declared Public Health Emergency. The spread of the Delta variant and rise in breakthrough hospitalizations may change this, but for now, this is CMS’ proposal.

There are also proposed changes regarding direct payment of Medicare. At present, Medicare is only allowed to make a payment to a PA’s employer or independent contractor. Beginning January 1st of next year, CMS proposes that Medicare should be able to pay PAs directly for services they provide under Part B, and that PAs should be able to bill them accordingly.

Here is where we get to telehealth. The explosive rise of telehealth services has been predicted for many years, but it took the pandemic to finally get people on board with the idea. These services have become widespread in the past year, and thus, CMS is proposing changes that would allow telehealth’s place in the future of Medicare to be assessed further.

To do this, CMS suggests allowing select services that were added to the Medicare telehealth list to remain on that list until the end of 2023. This would allow Medicare analysts time to figure out which telehealth services should still be covered in a post-pandemic world. Of note, the main emergency medicine CPT codes, 99281-99285, are on this list of codes approved for telehealth through 2023. However, CMS also suggests that certain critical care services that had previously been approved in a telehealth context (CPT 99468, 99471, 99473, 99475, 99477) ​​be recategorized and, eventually, removed at the end of the public health emergency.

CMS also acknowledges the danger of utilizing solely audio for health services. As such, they propose to both define this style of communication and limit its use. To do so, they suggest restricting the use of audio-only telemedicine to mental health services which have the capability of utilizing two-way audio/video communication, but are interacting with patients who either do not have or do not consent to video communication. In doing this, CMS encourages audio/video communication over simply audio.

Lastly, the new proposal from CMS changes the way in which providers bill for ‘shared’ services between a non-physician provider and a physician, so long as they are in a facility setting where they share the same group. This ability to share services would also apply for both new and established patients in both initial and subsequent visits. According to the policy, whoever is furnishing “more than half of the total time” of the visit must be the billing practitioner. This is a change from the current state, where a physician is the billing practitioner if there is a physician involved in the care for a shared service. This policy also broadens its scope to the use of the prolonged services code.

As you can see, the changes presented in this are numerous, though not all are final. We will keep you up to date as to the future of this proposal.