CMS Posts CY 2022 MPFS Proposed Rule
On July 13, 2021, the Centers for Medicare and Medicaid posted the public inspection version of a proposed rule titled, Medicare Program; CY 2022 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Provider Enrollment Regulation Updates; Provider and Supplier Prepayment and Post-payment Medical Review Requirements. The proposed rule puts forth provisions expected to be effective on 01/01/2022. The proposed rule is scheduled to be published to the Federal Register on 07/23/2021. Public comments are due by 09/13/2021.
CMS has also provided summaries of the proposed rule in a fact sheet and a press release. Below is a general summary of issues of particular relevance to therapy services.
The voluminous proposed rule also includes other topic areas, such as:
- Identification and Analysis of Potentially Misvalued Codes
- Pulmonary Rehabilitation Programs
- Collection of Health Equity Data
- Medicare Shared Savings Program Requirements
- Provider Enrollment Regulation Updates
- Provider and Supplier Prepayment and Post-payment Medical Review Requirements
- Updates to the Quality Payment Program; including the Merit-Based Incentive Payment System (MIPS) (which continues to not include institutional/agency providers)
- Updated Vaccine Payment Rates
- Medicare Diabetes Prevention Program (MDPP) Updates
- Removal of Select National Coverage Determinations
- Updates to the Physician Self-Referral Regulations
Medicare Physician Fee Schedule (MPFS) Conversion Factor
The proposed conversion factor is $33.5848, which is a decrease of $1.31 (-3.75%) from the CY 2021 conversion factor of $34.8931.
- This proposed update is reflective of the expiration of the CY 2021 3.75% increase provided by the Consolidated Appropriations Act of 2021, a 0.0% statutory update factor, and a -0.14% RVU Budget Neutrality Adjustment.
Fee Adjustments Due to Physician Evaluation and Management (E/M) Code Updates
- CMS notes that it is engaged in ongoing review of payment for E/M visit code sets, but has proposed no further refinements to the valuation of the E/M codes at this time.
- CMS has noted that the updated conversion factor is expected to have an impact of -2% on total allowed charges for physical and occupational therapy services (rather than the previously anticipated 8-9% decrease). (Note: Speech-language pathology services are not specifically addressed in Table 123: CY 2022 PFS Estimated Impact of Total Allowed Charges by Specialty of the rule.)
Occupational Therapy Assistant and Physical Therapist Assistant Modifiers (CO/CQ)
The proposed rule puts forth details regarding the planned implementation of the statutorily mandated 15% payment reduction for services requiring the assistant modifiers.
- CMS has put forth refined guidance, providing clarifications and examples to finalize the de minimis standard and the definitions of “in whole” and “in part”.
- CMS has indicated that payment will be made at 85% of the 80 percent of allowed charges, i.e. the reduction will only be applied to the 80 percent of Medicare-allowed charges and not applied to the 20% patient co-payment amount.
- The proposed rule stresses the expectation that documentation in the medical record will be sufficient to support whether a specific service was furnished independently or in part by an assistant.
Telehealth/Virtual Services
- CMS has indicated that requests to permanently add several therapy CPT® codes to the CMS List of Telehealth Services cannot be approved at this time, as the requests for addition of these codes did not meet CMS’ Category 1 or 2 criteria for permanent addition.
- To provide a more definitive discontinuation date than the end of the COVID-19 Public Health Emergency, CMS is proposing to continue the temporary addition of the therapy CPT® codes as Category 3 telehealth codes through the end of CY 2023. CMS has indicated that this timeframe is expected to allow time for more collection of utilization information and to provide opportunity for stakeholders to continue to develop support for the permanent addition of the codes to the CMS List of Telehealth Services.
- CMS is seeking comment on the proposal to revise the definition of “direct supervision” in certain settings in order to continue to allow physical and occupational therapists to supervise assistants through a virtual presence using real-time, interactive audio/ video communication technology instead of a physical presence, possibly to only a subset of services and with a requirement for a service level modifier to identify when supervision is provided by virtual presence.
At this time, no associated changes in practices for therapy service provision, coding, or billing are required. The federal rule-making process requires that the proposed changes and updates be affirmed by a final rule in order to be implemented.
Additional Resources
- Federal Register page for the MPFS Proposed Rule
- Quality Payment Program (QPP) Proposals Fact Sheet
- Physician Fee Schedule Federal Regulation Notices webpage (which provides access to related code, rate, worksheet, and analysis files)
