CY 22 Final Rules – Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment System
On November 2, 2021, the Centers for Medicare and Medicaid Services (CMS) issued the Final Medicare Physician Fee Schedule Rule (MPFS) for 2022, and the Final Hospital Outpatient Prospective Payment System Rule (OPPS) for 2022. Based on a preliminary review of the final rules, below are provisions of interest for Academy members.
The Academy has created 2022 reimbursement charts for audiology codes payable under the MPFS and OPPS, available on the Academy website.
Medicare Physician Fee Schedule
The 2022 Medicare conversion factor is reduced from $34.8931 to $33.5983, a cut of 3.71 percent. However, cumulative payment cuts resulting from several factors mean that some providers (depending on mix of services provided) could see payment cuts up to 9.75 percent.
This is due to:
- Expiration of the current reprieve from the 2 percent budget sequestration cut as required under the Budget Control Act of 2011. Congress originally scheduled this policy to sunset in 2021 but it will now continue into 2030.
- Imposition of a 4 percent Statutory PAYGO sequester resulting from passage of the American Rescue Plan Act. Should lawmakers fail to act, it will mark the first time that Congress has failed to waive Statutory PAYGO.
- Expiration of the Congressionally enacted 3.75 percent temporary increase in the Medicare physician fee schedule conversion factor to avoid payment cuts associated with budget neutrality adjustments tied to fee schedule policy changes. This increase expires December 31, 2021.
- A statutory freeze in annual Medicare fee schedule updates under the Medicare Access and CHIP Reauthorization Act (MACRA) that is scheduled to last until 2026, when updates resume at 0.25% a year.
We encourage all members to contact their federal lawmakers to ask for help in mitigating payment cuts. Watch for an Academy grassroots alert in the near future.
CY 2022 MPFS Estimated Impact on Total Allowed Charges by Specialty
CMS estimates the impact on Audiology to be 0 percent.
Extension of Covered Telehealth Services
There were no changes proposed for audiology telehealth services. However, it should be noted that CMS stated that they lack the statutory authority to maintain the telehealth flexibilities allowed during the federal public health emergency (PHE). Therefore, audiologists will no longer receive Medicare reimbursement for telehealth services when the PHE ultimately expires.
Quality Payment Program (QPP) and Merit-Based Incentive Payment System (MIPS)
CMS is moving ahead with extensive changes in MIPS. CMS will implement its MIPS Value Pathways (MVP) framework beginning in 2023, with seven options for participation in the first year. The initial MVP clinical areas include: rheumatology, stroke care and prevention, heart disease, chronic disease management, lower extremity joint repair (e.g., knee replacement), emergency medicine, and anesthesia. The goal of MVPs is to more effectively measure and compare performance across clinician types and provide clinicians with more meaningful feedback
For audiology, CMS will eliminate Quality Measure #154 – Falls: Risk Assessment: Percentage of patients aged 65 years and older with a history of falls that had a risk assessment for falls completed within 12 months. CMS states it is removing this measure because it is “topped out,” meaning the performance is high and CMS sees little opportunity to improve clinical outcomes. This leaves 8 measures available for reporting under the audiology measures set.
CMS will also maintain the exemption for audiology from the “promoting interoperability” and “cost” performance categories. Other MIPS performance categories (Quality and Improvement Activities) would be re-weighted to calculate the score for a participating audiologist.
More analysis of the MVP framework is needed to understand implications for audiologists as the program evolves. More information will be posted as analysis of the final rule continues.
Hospital Outpatient Prospective Payment System
In the final OPPS rule for 2022, CMS will increase OPPS payment rates for 2022 by 2 percent.
The OPPS provides technical component (TC) reimbursement (non-physician costs such as supplies, equipment and personnel) for services provided in the outpatient setting. Under the OPPS, services are assigned to an Ambulatory Payment Classification (APC) group, and all services in the group are reimbursed at the same rate. Services included in an APC are supposed to be clinically similar and similar in resource use.
Instead of using 2020 data for calendar year 2022 rate setting under the OPPS, CMS determined 2019 data are the best data available so that payment rates can accurately reflect estimates of the costs associated with furnishing outpatient services. This determination was made because of concerns about inadequate data due to the pandemic.
The Academy will continue to analyze these final rules for policy changes that may impact the profession.
Below are links to Academy-prepared data tables.
Both proposed rules can be accessed here.
The MPFS is released annually and updates payment policies, payment rates, and other provisions for services in Medicare. The most recent proposal was issued July 6, 2022, and includes a proposal for limited direct access to audiology services in Medicare. Under this proposal, “non-acute,” non-vestibular services (36 codes) may be provided without a physician order…
Late July 15, 2022, the Centers for Medicare and Medicaid Services (CMS) issued the proposed rule on the 2023 Hospital Outpatient Prospective Payment System (OPPS). Under this proposal, CMS proposes a 2.7 percent increase in the OPPS payment rate for 2023. The OPPS provides technical component (TC) reimbursement (non-physician costs such as supplies, equipment, and…
2023 Propose Rule on the Hospital Outpatient Prospective Payment System (OPPS) Tables 1-7 see below for Ambulatory Payment Classification (APC) assignments, status indicators (SI), and reimbursement amounts for audiology codes. An “S” status indicator denotes a “Separate APC Payment,” where regardless of services performed on the same date of service, the CPT code is paid…