Updated December 2021
Following the November 2, 2021 publication of the annual Medicare Physician Fee Schedule final rule by the Centers for Medicare & Medicaid Services (CMS), several updates have been made impacting the Conversion Factor. On December 10, legislation was signed averting an almost 10% cut to the fee schedule, which was scheduled to take effect January 1. AAPM&R advocated against these cuts throughout 2021, culminating in a grassroots advocacy campaign this November, during which 208 members sent a total of 635 messages to their Congressional Leaders. As a result, rather than a 10% cut, the fee schedule will see a 0.83% cut to payment. As of late December, CMS has finalized a 2022 Conversion Factor of $34.6062, decreased from the 2021 Conversion Factor of $34.8931.
Click here for a chart of final RVUs and payment rates for physiatry services effective January 1, 2022 reflective of the updated $34.6062 Conversion Factor.
While the December 10 legislation is a huge win for physiatry and the entire house of medicine, the changes to physician payment in the bill are only a temporary solution, as they expire at the end of 2022. We anticipate we will be advocating early and throughout 2022 to urge Congress to identify a permanent solution to the payment cuts physicians have been facing each year in recent history.
The rule finalizes payment and policy changes which will take effect January 1, 2022. Earlier this year, your Academy submitted detailed comments to CMS regarding the proposed rule. The rule also finalizes policy on several issues your Academy has been monitoring including:
A comprehensive fact sheet is now available on the CMS website.
On December 1, 2020, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule Final Rule which finalizes payment rates and policies effective January 1, 2021. Your Academy submitted comments to the proposed rule in early October.
The Consolidated Appropriations Act, signed into law on December 27, 2020, included adjustments to the 2021 conversion factor. These adjustments result in a finalized 2021 conversion factor of $34.89. This is a 3.3% reduction from the 2020 conversion factor of $36.09, which is a far smaller reduction than the one originally finalized in early December 2020.
We developed a code-by-code summary of 2021 payment compared to 2020 payment, available to AAPM&R members here. This summary is updated to reflect the new 2021 conversion factor and other relevant changes resulting from the Consolidated Appropriations Act. The impact of the final rule on payment varies significantly based on the services being provided.
Overall themes include:
CMS finalized its proposal to adopt the new CPT code descriptors and guidelines for office and outpatient E/M services. These changes include elimination of code 99201. Guidelines and code descriptors now reflect that code selection should be based on either medical decision making or time. For more detailed information regarding the updates to the office and outpatient E/M code set, visit our 2021 E/M webpage.
Along with the CPT updates to office and outpatient E/M, CMS has finalized a new HCPCS code for prolonged services when billed with office and outpatient E/M.
G2212 – Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service: each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact.
Note: Coding guidelines for prolonged services codes billed with other E/M remain the same. Further, it is unclear at this time whether other payors will choose to reimburse for G2212.
CMS finalized its proposal to allow NPs, CNSs, PAs, CRNAs and CNMs to supervise diagnostic tests where allowed by state scope of practice laws. This is a permanent scope of practice expansion of current allowances made under the pandemic. AAPM&R opposed this scope of practice expansion in our comment letter to CMS. We urged CMS to re-instate physician supervision requirements of diagnostic tests after the PHE.
CMS finalized its proposal to permanently allow teaching physicians to meet requirements to bill for services involving residents through virtual supervision. Through the pandemic, this expansion covers all teaching settings. However, following the pandemic, the permanent expansion is limited to services furnished in residency training sites that are located in rural areas.
CMS also finalized its proposal to allow a physical therapist (PT) or occupational therapist (OT) who establishes a maintenance program to assign the duties to a physical therapist assistant (PTA) or occupational therapy assistant (OTA), as clinically appropriate, to perform maintenance therapy services.
CMS finalized its proposal to permanently expand the Medicare telehealth list to include:
CMS also temporarily expanded the Medicare telehealth list to include:
Visit the CMS website for the complete Medicare telehealth list.
CMS clarified that at the conclusion of the public health emergency (PHE) it will no longer be offering separate payment for audio-only E/M visit codes. Following the PHE, audio-only services will be categorized as bundled. It should also be noted that following the PHE, CMS coverage of telehealth will be restricted to services offered to patients in healthcare professional shortage areas.
Your Academy previously announced CPT finalized a new code, 99072, for additional PPE and clinical staff time associated with services during the pandemic. AAPM&R has urged CMS and other payors to cover this service. However, CMS has finalized that it will not separately pay for code 99072. CMS is accepting comments on this issue, and your Academy will continue to advocate for payment to reflect that additional costs associated with supplies and staff time during the pandemic.
CMS finalized the following provisions for the 2021 Merit-Based Incentive Payment System (MIPS) reporting, which impacts 2023 Medicare Part B payments:
Your Academy will provide additional 2021 QPP education and educational materials in the spring.
Congress passed legislation in 2018 requiring Medicare Part D prescriptions for controlled substances to be electronically prescribed starting in 2021, with some exceptions. In the final rule, CMS reiterated the rationale for its proposal to defer the EPCS mandate until 2022, but also noted that some commenters urged the agency to require EPCS in 2021 even if it declines to enforce the requirement until 2022. As such, CMS finalized that electronic prescribing for controlled substances for Medicare prescriptions will begin in 2021 and compliance will be required beginning in 2022.
The complete rule is available on the Federal Register website.
A detailed CMS fact sheet is available on the Medicare website.
Medicare payment for physicians, and some non-physician practitioners (NPPs), is based on set rates under Medicare Part B. The system for payment, known as the Medicare Physician Fee Schedule (MPFS), is used when paying for: professional services of physicians and some NPPs; covered services incident to physicians’ services (other than certain drugs covered as incident to services); diagnostic tests (other than clinical laboratory tests); and radiology services. The MPFS also addresses various quality issues, fraud and abuse issues, and other issues that impact physicians. CMS updates the MPFS regulations annually, with comment periods open prior to implementation of the final rule.
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