US CMS CY 2022 Payment Rates Available for MPFS and HOPD

On November 2, 2021, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2022 Medicare Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (OPPS) Final Rules. The rules will be posted in the Federal Register no later than November 19, 2021.

Topline Takeaways

  • CMS finalizes payment rate for CPT code +93319
  • Four-year transition period to implement the clinical labor pricing update
  • CMS will extend, through the end of CY 2023, with the inclusion of certain Medicare telehealth services 

CY 2022 Medicare Physician Fee Schedule Final Rule

Conversion Factor & Impact to Echocardiography

Overall, the final CY 2022 PFS conversion factor is $33.59, a decrease of $1.30 from the CY 2021 PFS conversion factor of $34.89. The PFS conversion factor reflects the statutory update of zero percent and the adjustment necessary to account for changes in relative value units (RVUs) and expenditures that would result from our finalized policies. Congress intervened late last year to avert significant Medicare physician payment cuts this year, including providing a 3.75 percent payment increase that will expire at the end of 2021 unless Congress steps in again.

ASE continues to work in coalition with national and state medical societies urging Congress to act before January 1, 2022 to extend the existing 3.75 percent adjustment and prevent a Medicare sequestration, that will result in an across-the-board cut in Medicare provider payments, next year that could total as much as 6.0 percent. 

New Add-on CPT Code and Value for 3D

CMS finalized a work valuation of 0.50 RVUs for CPT code +93319 – 3D echocardiographic imaging and postprocessing during transesophageal echocardiography, or during transthoracic echocardiography. ASE is pleased that CMS accepted the AMA RUC recommendations for this service and wishes to thank Drs. Susan Mayer, Michael Main, Geoffrey Rose, Piers Barker, and Gregory Ensing for all their hard work. We could not have accomplished this without their efforts.

Clinical Labor Update

For the first time in nearly 20 years, CMS is updating the clinical labor rates that are used to calculate practice expense under the PFS. There will be a four-year transition period to implement the clinical labor pricing update, which will help maintain payment stability and mitigate any potential negative effects on healthcare providers by gradually phasing in the changes over time. ASE appreciates the four-year phase in of these changes to avoid future volatility within the fee schedule.

Telehealth Services under the PFS

CMS will continue to evaluate telehealth services that were temporarily added to the Medicare telehealth services list during the COVID-19 public health emergency (PHE). They have finalized an extension, through the end of CY 2023, for the inclusion of certain telehealth services temporarily added to the Medicare telehealth services list that would otherwise have been removed at the end of the COVID-19 PHE, or December 31, 2021. However, CMS has not officially extended the PHE and acknowledges there is uncertainty regarding the timing of their processes about the end of the PHE.

CY2022 Medicare Hospital Outpatient Prospective Payment Systems (OPPS) Final Rule 

Conversion Factor

In accordance with the Medicare statute, CMS is updating the CY 2022 OPPS payment rates for hospitals that meet applicable quality reporting requirements by 2.0 percent. This update is based on the projected hospital market basket increase of 2.7 percent, reduced by 0.7 percentage point for the productivity adjustment.

Use of CY 2019 Claims Data for CY 2022 OPPS Payment System Rate Setting Due to the PHE

CMS clarified that for the OPPS rate setting process, the best available data is used so that the payment rates can accurately reflect estimates of the costs associated with furnishing outpatient services. Ordinarily, the best available claims data is the most recent set of data, which would be from two years prior to the calendar year that is the subject of rulemaking. However, due to a number of COVID-19 PHE-related factors, CMS believes that the CY 2020 data are not the best overall approximation of expected outpatient hospital services in CY 2022. Instead, CMS believes the CY 2019 data, as the most recent complete calendar year of data prior to the COVID–19 PHE, are generally a better approximation of expected costs for CY 2022 hospital outpatient services for rate setting purposes. As a result, CMS is generally using CY 2019 claims data to set the CY 2022 OPPS payment system rates.

To view the Final CY 2022 Payment Rates – MPFS and HOPD, please log in to the ASE Member Portal and visit the Advocacy Portal page.

Below are links to CMS Fact Sheets for both rules.

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