2022 MEDICARE PHYSICIAN FEE SCHEDULE (MPFS)
PROPOSED RULE RELEASED
Includes 2022 Quality Payment Program Proposals
Proposed 2022 Conversion Factor: $33.5848
On July 13, CMS released the CY 2022 MPFS Proposed Rule. CMS also released a press release, a physician fee schedule fact sheet, and a QPP fact sheet. ASCRS will be submitting comments.
2022 MPFS Conversion Factor
The CY 2022 proposed MPFS conversion factor is $33.5848, a decrease of approximately 3.89% ($1.31) from the CY 2021 MPFS conversion factor of $34.8931. The CY 2022 proposed MPFS conversion factor reflects a budget neutrality adjustment of -0.14%, the expiration of the 3.75% payment increase provided for CY 2021 by the Consolidated Appropriations Act, and the 0.00% update adjustment factor as established in MACRA.
According to the CMS estimated impact on total allowed charges by specialty, ophthalmology is impacted by 0%. However, it is not clear whether the 3.75% reduction is included in the impact table. For CY 2022, the proposed Medicare payment rate for 66984 is $530.98, a decrease of $17.19 from the CY 2021 Medicare payment of $548.17.
We will continue to advocate with the medical and surgical community to prevent these Medicare physician payment cuts.
New Cataract and Micro-Invasive Glaucoma Surgery (MIGS) Combinations Codes
Unfortunately, CMS did not accept the AMA RVS Update Committee (RUC) recommendations for the new Category I CPT codes that describe MIGS procedures when performed in conjunction with cataract surgery. The table below shows the RUC work RVU recommendation and the CMS proposed work RVU. ASCRS will be providing comments on the proposed work recommendations and will include a rationale for why the original RUC recommendations should be accepted.
E/M Visits
CMS is proposing to refine its longstanding policies for split (or shared) E/M visits to reflect the role of non-physician practitioners (NPPs) as members of the medical team, and to clarify conditions of payment that must be met to bill Medicare for these services. In the CY 2022 MPFS proposed rule, CMS is proposing the following:
- Definition of split (or shared) E/M visits as evaluation and management (E/M) visits provided in the facility setting by a physician and an NPP in the same group.
- The practitioner who provides the substantive portion of the visit (more than half of the total time spent) would bill for the visit.
- Split (or shared) visits could be reported for new as well as established patients, and initial and subsequent visits, as well as prolonged services.
- Requiring reporting of a modifier on the claim to help ensure program integrity.
- Documentation in the medical record that would identify the two individuals who performed the visit. The individual providing the substantive portion must sign and date the medical record.
- Codifying these proposals and revised policies in new regulations at 42 CFR 415.140.
Unfortunately, this proposed rule does not include increases to the value of E/M post-operative services in 10- and 90-day global surgery codes. ASCRS will continue to work with the surgical community advocating that Congress direct the CMS to adjust the values of the E/M post-operative visits included in 10-day and 90-day global surgical codes to reflect the updated office/outpatient E/M code payment increases that were implemented on January 1, 2021.
Medicare Telehealth Services
For CY 2022, CMS is proposing to allow certain services added to the Medicare telehealth list to remain on the list to the end of December 31, 2023, so that there is a glide path to evaluate whether the services should be permanently added to the telehealth list following the COVID-19 PHE.
Quality Payment Program
MIPS Value Pathways (MVPs)
CMS has developed 7 new MVPs and proposes they be available beginning with the 2023 performance year, which does not include ophthalmology. This is a result of advocacy by ASCRS and the ophthalmic community. The addition of MVPs is part of a greater effort at CMS to sunset traditional MIPS after the end of the 2027 performance period/2029 payment year. CMS did not propose the timeframe in which MVP reporting would no longer be voluntary and said any proposal to sunset traditional MIPS will be made in future rulemaking. ASCRS will be providing comments explaining that the traditional MIPS pathway should not be terminated.
Performance Threshold Proposals
CMS is proposing to establish the performance threshold using the mean final score from the 2017 performance year/2019 MIPS payment year, which would result in a performance threshold of 75 points. The additional performance threshold would be established at 89 points. The additional MIPS adjustment factors for exceptional performance are available through the 2022 performance year/2024 MIPS payment year, making this the last year of the additional performance threshold and the associated additional MIPS adjustment factors for exceptional performance.
Performance Category Weights
For the 2022 performance year/2024 payment year, CMS is proposing the following performance category weights:
- 30% for the Quality performance category.
- 30% for the Cost performance category.
- 15% for the Improvement Activities performance category.
- 25% for the Promoting Interoperability performance category.
Additional Details to Come
Additional information will be detailed in upcoming editions of Washington Watch Weekly.