Advocacy Update: CMS Proposed Rule

CMS Releases CY 2022 Medicare Physician Fee Schedule with Cuts Slated for January 1st. On July 13th, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for the calendar year (CY) 2022 Medicare Physician Fee Schedule (MPFS). The proposed rule puts forward payment and quality measurement policies for the upcoming calendar year.

CY 2022 MPFS Conversion Factor

CMS proposes a CY 2022 conversion factor of $33.5848, $1.3083 less than the current conversion factor of $34.8931. This reduction is due to two factors. First, the MPFS is subject to budget neutrality requirements that can cause the Agency to adjust the conversion factor downward to “pay for” increased spending otherwise caused by its proposals. This year, that budget neutrality reduction to the conversion factor is -0.14%. Second, at the end of 2020, Congress passed a provision that helped boost payments for 2021 by 3.75% in order to fill the hole created by last year’s budget neutrality adjustment. That provision expires this year, and without Congressional action will be the main driver of the significant drop in the conversion factor for CY 2022.

ASBrS has been actively engaged with Members of Congress and partners in the Surgical Coalition and broader provider community, urging Congress to act to avoid these cuts. Most recently, ASBrS joined 108 other organizations urging leadership in Congress to address this issue before the end of the year. It is important to note that these cuts are compounded by CMS’ failure to provide increases to the global surgical packages commensurate with the 2021 increases to the values of the office and outpatient E/M code set, as it has always done in the past. Please note that the Society continues to actively engage with legislative staff on this ongoing issue. On July 22nd, ASBrS also joined the Surgical Coalition in a letter to CMS Administrator Chiquita Brooks-LaSure urging that Agency remedy this in this year’s rulemaking.

Telehealth Services

CMS revisited their telehealth policies in light of the ongoing billing flexibilities it has issued during the COVID-19 public health emergency (PHE). CMS had previously approved a number of MPFS services as eligible to be furnished via telehealth “through the end of the year in which the PHE ends.” In this rule, CMS proposes that the codes on that list would be approved through the end of 2023, even if the PHE were to end earlier. CMS also puts forward proposals to place restrictions on the use of audio-only telehealth so that it is billable only for the diagnosis, evaluation, or treatment of mental health disorders furnished to established patients when certain conditions are met.

In addition, outside of the PHE telehealth flexibilities, statute requires that in order to bill for telehealth services, the patient must physically be at an “originating site.” CMS maintains a specific list of originating sites, and here CMS proposes to add Rural Emergency Hospitals (REHs) as an originating site in 2023, the first year in which this new facility designation will exist.

Virtual Services

CMS also maintains policies for a series of virtual or remote services (i.e., services that by definition cannot be performed in person). In this year’s rule, CMS proposes to permanently adopt coding and payment for CY 2022 HCPCS code G2252 (Virtual check-in, 11-20 minutes). CMS also seeks information on whether to extend the availability of the PHE flexibility allowing direct supervision via virtual presence using real-time audio/video technology or to make it permanent. This flexibility is currently available through the end of the year in which the PHE ends.

ASBrS will submit comments in response to the rule, as well as continue to engage with Congressional leaders to avert the cuts scheduled for the beginning of the year.

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