NASS Insider

August 31, 2021

CMS Publishes Proposed Rules for 2022 Medicare Payments to Physicians and Outpatient Departments/ASCs

The Centers for Medicare and Medicaid Services (CMS) recently released proposed rules for 2022 Medicare payments to physicians and hospital outpatient departments/ambulatory surgical centers (ASCs). Several significant changes have been proposed and are summarized below.

NASS will submit comments on both proposed rules and the final rules are expected to be published around November 1 for implementation January 1, 2022.

Physician Fee Schedule Rule

  • Conversion Factor. In the 2022 Medicare Physician Payment Proposed Rule, the most significant proposed policy change is a 3.75% reduction in the 2022 Medicare conversion factor due to the expiration of previous temporary funding patches and Medicare sequestration.

    NASS is working on both the legislative and regulatory fronts to try to stop these payment cuts and to ensure that changes in underlying payment policies do not counteract efforts to protect our health care system and ensure patient access to care particularly during the ongoing public health emergency (PHE).
  • Telehealth. CMS is proposing to add over 100 CPT codes to the temporary Medicare approved telehealth list for the COVID PHE, which would extend their coverage through 2023. Additionally CMS is proposing permanent adoption of code G2252 for an extended (11-20 minutes) virtual check-in provided with any form of synchronous communication including audio-only visits.
  • MIPS. CMS proposed that implementation of the MIPS Value Pathway begin in 2023 with sunset of traditional MIPS proposed for the end of the performance and data submission periods in 2027.
  • AUCs. CMS proposed delay of implementation of the Appropriate Use Criteria (AUC) program for advanced diagnostic imaging until January 1, 2023 or the first January after the COVID PHE.
The impact of all of the changes in the proposed rule by spine specialty are indicated in table 1.
Table 1
Specialty Impact on Payment
Anesthesiology +1%
Chiropractor 0%
Interventional Pain Management >+1%
Neurosurgery 0%
Orthopedic Surgery +1%
Physical Medicine >0%
Physical/Occupational Therapy -2%
Source:, Table 123.


In the 2022 Medicare OPPS/ASC Payment Proposed Rule, CMS is proposing to increase hospital outpatient and ASC rates by 2.3%. Other significant changes include:

  • Inpatient Only List. CMS is proposing to stop their planned phase-out of the inpatient-only (IPO) list, a list of over 1,700 services that are allowed to be provided only in an inpatient setting under Medicare. They are seeking comment on whether they should proceed with discontinuation of the list or if they should modify how they evaluate services for inclusion on the list and potential safety and quality of care implications for either approach.

    CMS also is proposing to restore the 298 codes removed from the IOL in 2021. The 298 codes are predominantly musculoskeletal, including total disc arthroplasty, placement of posterior intrafacet implants, excision of vertebral body, osteotomy, open treatment of vertebral fracture, arthrodesis, kyphectomy, and instrumentation.
  • ASC Covered Procedures List. In tandem with the IPO list proposal, CMS is proposing to halt expansion of the ASC covered procedures list (CPL) and to remove 258 of the 267 procedures added to the CPL in 2021 out of concern that many of the procedures are only safe in the outpatient setting for healthier patients and may pose a risk for typical Medicare beneficiaries. The 258 codes proposed for removal include laminectomy, laminotomy, decompression, and discectomy. CMS is soliciting comments on the process for adding procedures to the CPL.