2022 MPFS final rule revamps split/shared visit billing, expands telehealth

Wednesday, November 3, 2021

The 2022 Medicare Physician Fee Schedule (MPFS) final rule ushers in significant changes to billing for split/shared visits, telehealth coverage, and more.

Split/shared visits

The 2022 MPFS final rule, released November 2, finalizes many of the revisions to split/shared visits and critical care visits discussed in the proposed rule. However, the new rules for billing split/shared visits will be phased in, and CMS also scaled back its proposal to ban payment for critical care services during the global surgery period for any service.

According to the final rule, effective January 1, 2022, split/shared visits may be performed in any facility setting and for critical care services. Split/shared visits, except for critical care visits, should be reported by the treating practitioner (i.e., the physician or qualified healthcare professional) who performs the “substantive portion” of the visit as determined by history, physical exam, medical decision-making, or more than half of the total time of the encounter. Critical care should be billed by the treating practitioner based on time.

Split/shared visits may be reported for new and established patients and for initial and subsequent encounters. Starting January 1, 2022, CMS will require a modifier to be reported with split/shared visits, although the agency has yet to specify the modifier.

Telehealth

Category 3 telehealth codes approved during the COVID-19 public health emergency will be kept through the end of 2023 at least. These codes would originally have been removed at the end of 2022. CMS extended the codes to allow stakeholders more time to provide feedback before the agency reaches a final decision and to reduce uncertainty about processes related to the end of the public health emergency.

The final rule also adds the following Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes to these Category 3 codes:

  • CPT code 93797, physician or other qualified healthcare professional services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session)
  • CPT code 93798, physician or other qualified healthcare professional services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session)
  • HCPCS code G0422, intensive cardiac rehabilitation; with or without continuous ECG monitoring with exercise (per session)
  • HCPCS code G0423, intensive cardiac rehabilitation; with or without continuous ECG monitoring without exercise (per session)

 

HCPCS code G2252 (brief communication technology-based service, e.g., virtual check-in, by a qualified healthcare professional who cannot report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion) is added on a permanent basis.

Most provisions of the final rule are effective January 1, 2022. Revenue integrity professionals should review the final rule, paying particular attention to sections that directly affect their  organization, and ensure that chargemasters and other systems are updated as appropriate.

Editor’s note: Some information in this article originally appeared on Part B News.

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