2022 MPFS proposed rule: Conversion factor cut, telehealth and AUC updates

CMS is proposing a 4% decrease to the Medicare conversion factor, permanent expansion of telehealth coverage for some mental health services, and new timelines for Appropriate Use Criteria (AUC) reporting, according to the 2022 Medicare Physician Fee Schedule (MPFS) proposed rule, released July 13.

Conversion factor

The proposed 2022 conversion factor comes in at $33.58, down $1.31 from the current-year conversion factor of $34.89.

The rate cut is a result of mandated budget neutrality adjustments and the expiration of the one-year 3.75% increase that was set in motion by the Consolidated Appropriations Act of 2021.

The 2022 anesthesia conversion factor is projected to fall to $21.04 in 2022, a 2% decrease from the $21.56 rate in 2021.

The combined impact of the proposed 2022 conversion factor decrease will have a far more muted effect on specialties than the 2021 rulemaking period, which saw wild swings in payments. Most specialties, for instance, will see payment changes of 1% or 2%, either positive or negative, in 2022, according to CMS’ payment projections.

However, there are several outliers. Interventional radiology is projected to see a 9% payment cut in 2022, according to Table 123 in the proposed rule. Vascular surgery would see an 8% reduction. The biggest increase—and the only specialty above 2% in the black—is for portable X-ray suppliers, where CMS proposes 10% in payment gains. Numerous others, including endocrinology and family practice, would see a 2% pay increase.

Telehealth updates

No new codes have been added to those CMS has allowed providers to use during the COVID-19 pandemic. CMS says it "found that none of the requests we received by the February 10 submission deadline met our Category 1 or Category 2 criteria for permanent addition to the Medicare telehealth services list."

However, CMS proposes to grant greater leeway to mental health services provided via telehealth. "CMS is proposing to implement recently enacted legislation that removes certain statutory restrictions to allow patients in any geographic location and in their homes access to telehealth services for diagnosis, evaluation, and treatment of mental health disorders," the agency states in the proposed rule.

Stakeholders have proposed numerous codes be permanently approved for telehealth. However, CMS is declining to consider many of them, including the following services:

• Urodynamics
• Biofeedback
• Neurological and psychological testing
• Therapy procedures and physical therapy evaluations
• Therapy test and measurement, therapy personal care, personal care and evaluation therapy services

See the proposed rule for the complete list.

CMS is “proposing to revise the timeframe for inclusion of the services we added to the Medicare telehealth services list on a temporary, Category 3 basis” and to “to retain all services added to the Medicare telehealth services list on a Category 3 basis until the end of CY 2023.”

But dozens of codes CMS added on an interim basis to respond to the COVID-19 public health emergency that were not extended on a temporary Category 3 basis in the 2021 MPFS final rule are listed to be cut, pending comments to the rule.

CMS may “amend the current regulatory requirement for interactive telecommunications systems” to allow greater use of audio-only telehealth, at least for mental health disorders furnished to established patients in their homes, but with stricter guidelines and a new modifier.

AUC

CMS is proposing to delay the AUC program payment penalty to January 1, 2023, or the January 1 following the end of the COVID-19 public health emergency, whichever is later. The payment penalty for failing to comply with AUC requirements is currently set to begin January 1, 2022.

This isn’t the first time CMS has pushed back full enforcement of AUC. In September 2020, the agency extended the education and operations testing period for AUC through 2021. The education and operations testing period, which started January 1, 2020, was slated to close at the end of 2020. Payment penalties were originally scheduled to go into effect January 1, 2021.

CMS developed the AUC program to meet requirements of the Protecting Access to Medicare Act of 2014 (PAMA). PAMA created a new program to help ensure that advanced diagnostic imaging services—PET scans, MRIs, CT scans, and nuclear medicine—provided to Medicare beneficiaries are appropriate and medically necessary. The program was finalized in the 2017 MPFS final rule, and CMS finalized requirements for consulting and reporting in the 2018 MPFS, with additional updates included in the 2019 MPFS.

Other proposals

CMS is proposing measures to increase participation in the Medicare Diabetes Prevention Program and make changes to the Quality Payment Program, as well as seeking feedback on data collection.

The agency is also requesting feedback on payments for vaccine administration. In the 2022 MPFS fact sheet, CMS notes that payments for preventive vaccines, such as flu, pneumonia, and hepatitis B, have decreased by approximately 30% over the past seven years. In the proposed rule, the agency is requesting information on the types of providers who furnish vaccines and the associated costs. CMS is also seeking feedback on its $35 add-on payment for administration of a COVID-19 vaccine in a patient’s home and the classification of COVID-19 monoclonal antibody products as vaccines, as well as how these products should be treated after the end of the public health emergency.

Comments on the proposed rule are due by 5 p.m. on September 13.

Editor’s note: For more information, see NAHRI’s resources on telehealth billing, coding, and coverage, AUC, and COVID-19 vaccine billing, coding, and coverage.

Some information in this article was originally published on Part B News. Register for Decision Health’s 2022 MPFS proposed rule webinar.