CMS Releases Proposed Rule on Physician Fee Schedule

The Centers for Medicare & Medicaid Services (CMS) recently released the calendar year 2022 Medicare Physician Fee Schedule proposed rule. The rule proposes a conversion factor of $33.58, a decrease of $1.31 from the calendar year 2021 conversion factor of $34.89. The updated conversion factor is budget neutral to account for changes in relative value units and the expiration of the 3.75% payment increase provided in the 2021 Consolidated Appropriations Act. The proposed rule also includes provisions to expand telehealth for mental health services and include coverage for audio-only services in certain instances. Highlights for the proposed rule include the following:

  • Telehealth Services: The CMS continues to evaluate the temporary expansion of telehealth services that were added to the telehealth list during the COVID-19 public health emergency. The CMS proposes certain telehealth services remain on the list until Dec. 31, 2023, so there is a glide path to evaluate whether the services should be permanently added to the telehealth list. The agency is proposing including audio-only communication when used for telehealth services for the diagnosis, evaluation or treatment of mental health disorders furnished to established patients in their homes. It is also proposing to require use of a new modifier for services furnished using audio-only communications.
  • Medicare Shared Savings Program: The CMS is proposing to freeze the quality performance standard for program year 2023 and revise the methodology for calculating repayment mechanism amounts for risk-based accountable care organizations. The Quality Payment Program Fact Sheet provides additional details.
  • Vaccine Administration Services: The proposed rule includes a comment solicitation to obtain information on the costs involved in furnishing preventive vaccines, with the goal to inform the development of more accurate rates for these services.
  • Opioid Treatment Program (OTP) Payment Policy: The CMS is proposing to allow OTPs to furnish counseling and therapy services via audio-only interaction after the conclusion of the COVID-19 public health emergency in cases where audio/video communication is not available to the beneficiary.
  • Electronic Prescribing of Controlled Substances (EPCS): The CMS is proposing certain exceptions to the EPCS, which requires electronic prescribing of controlled substances for schedule II, III, IV and V controlled substances covered through Medicare Part D.
  • Requiring Certain Manufacturers to Report Drug Pricing Information for Part B: The CMS is proposing to make regulatory changes to implement the new reporting requirements for drug manufacturers with Medicaid Drug Rebate Agreements.
  • Clinical Laboratory Fee Schedule: The CMS is seeking comments on policies for specimen collection fees and the travel allowances for homebound patients and inpatients (not in a hospital).

Comments on the proposal are due Sept. 13. Members with questions should contact Renée Smiddy at the MHA.