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Medicare Proposed Rule for CY 2022: Physician Fee Schedule 


Release Date: July 13, 2021
Federal Register Publication Date: TBD
Effective Date: TBD

Physician Fee Schedule Proposed Rule: 

Update Factors*:  Final CY21   Proposed CY22
PFS Conversion Factor       34.89% 33.58%

*PFS conversion factor reflects the statutory update of 0.00 percent and the adjustment necessary for changes in relative value units and expenditures. 

Physician Fee Schedule (PFS) are for physician and other billing professional services. Physicians’ services paid under PFS are provided in various settings. Some takeaways from proposed rule include:

  • Refine current policies for split (or shared) E/M visits, critical care services, and services furnished by teaching physician involving residents. 
  • Refine the policies for critical care services. 
  • Clarify the time when teaching physician can be included when determining E/M visit level. 
  • Allow certain services added to the Medicare telehealth list and expand telehealth services. 
    • Require providers to conduct in-person, non-telehealth service within six months prior to providing an initial mental health service, and at least once every six months thereafter.
    • Allow the use of audio-only telehealth services for the diagnosis, evaluation, or treatment of mental health disorders furnished to established patients in their homes, but only if the beneficiary is unable to or have access to two-way, audio/video technology. 
  • Revise standard established for services provided by Physical Therapy Assistants (PTA) and Occupational Therapy Assistants (OTA) in to allow a timed service to be billed without the CQ/CO modifier in cases when PTA/OTA participates in providing care to the patient. 
  • Provisions proposed to enhance the abilities of RHCs and FQHCs to furnish care to underserved Medicare beneficiaries. 
    • Allow RHCs and FQHCs to report and receive payment for mental health visits furnished via real-time telecommunication technology in the same way as in-person visits.
    • FQHC and RHCs eligible to receive payment for hospice attending physician services when provided by FQHC/RHC physician, nurse practitioner, or physician assistant who is employed by an FQHC/RHC. 
  • CMS proposes changes to the Medicare Shared Savings Program (MSSP) including the quality measure participants report. 
  • Provider enrollment regulatory revisions to strengthen program integrity. 

Sources: CMS CY 2022 Medicare Physician Fee Schedule Proposed Rule

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