December 07, 2021
CMS Publishes 2022 Medicare Payment Final Rules
The Centers for Medicare and Medicaid Services (CMS) recently released the final rules for 2022 Medicare payments to physicians and hospital outpatient departments/ambulatory surgical centers (ASCs). The final rules will be implemented January 1, 2022.
Physician Fee Schedule Rule
Conversion Factor. CMS finalized a 3.71% reduction (to $33.5983) in the 2022 Medicare conversion factor due to budget neutrality and other statutorily-mandated requirements.
Congress is allowed to waive budget neutrality during a public health emergency and can act to mitigate the cut using its administrative authority. Therefore, NASS Advocacy is continuing outreach to Congress to request that they take the necessary steps to prevent this significant pay cut.
Telehealth. CMS finalized its proposal to extend coverage through 2023 for over 100 services that had been added to Medicare approved telehealth list that were added temporarily during COVID. Additionally, CMS permanently adopted coding and payment for code G2252 for virtual check-in visits.
Quality Payment Program (QPP). CMS finalized its proposal to delay implementation of the MIPS Value Pathways (MVPs) to 2023. CMS has not enacted its proposal to sunset traditional MIPS at the end of the 2027 performance period and noted that it will continue to consider when this will happen.
Refinement of Relative Work Values (RVUs)
In the proposed rule, CMS had rejected the RUC recommended work RVUs for several spine codes. NASS was successful in persuading CMS to increase the work RVUs for new codes 63052 and 63053 (add-on decompression codes) for 2022 to be closer to the RUC recommended values.
CMS is increasing hospital outpatient and ASC rates by 2.0%. Additionally, CMS is finalizing its proposal to halt elimination of the inpatient-only (IPO) list, a list of over 1,700 services that are allowed to be provided in an inpatient setting only under Medicare. CMS is reinstating virtually all of the codes removed from the IPO list in 2021 with the exception of CPT code 22630 (Arthrodesis, posterior interbody technique) as well as several other orthopedic and anesthesia codes. As part of this policy, CMS is also re-instating the ASC covered-procedures list (CPL) criteria and adding a mechanism for stakeholders to request that procedure be added to the CPL in the future.
Additional information on both final rules, including impact by specialty and the values of spine-specific codes, will be covered in the November/December issue of SpineLine.