Fee Schedule Updates - 2022

The fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers. The CMS develops a fee schedules for following services,

• Physicians Services,
• Ambulance services,
• Clinical laboratory services, 
• Durable Medical Equipment Services,
• Prosthetics Services,
• Orthotics Services,
• Supplies Services.

The Overall, neurosurgery will receive a 3.2% payment cut in 2022. The cut stems from a lower conversion factor from $34.89 in 2021 to $33.58 in 2022. 

In the final rule CMS lowered the conversion factor (CF) from $34.89 in calendar year of 2021 to $33.59 for CY 2022, a decrease of $1.30 (-3.7%). 

This is due in part to the expiration of the 3.75% payment increase provided for in Year of 2021 by the Consolidated Appropriations Act of 2021

With the 2% Medicare sequester set to resume next year and additional Medicare payment cuts of up to 4% possible under pay-as-you-go rules to pay for the American Rescue Plan, providers could be facing up to 9% in payment cuts next year unless Congress intervenes.

Absent congressional actions, a 9.75% cut was scheduled effective January 1, 2022.

*Congress reduced 3% of the scheduled 3.75% cut to the Medicare Physician CF.

Evaluation and management (E/M) visits

The CMS clarifies and refines policies related to split (or shared) evaluation and management (E/M) visits, critical care services, and services furnished by teaching physicians involving residents. 

The Split (or shared) E/M visits are defined as visits provided in a facility setting by a physician and a non-physician provider in the same group. 

The practitioner who provides the substantive portion of the visit would bill for the visit. For 2022, the substantive portion is determined based on the below information,

• Medical History, 
• Physical Exam, 
• Medical Decision Making OR 
• More than half of the total time.

Additionally, critical care services will not be bundled in a global surgical period if unrelated to the surgical procedure. 

The rule clarifies that when a resident participates in providing a service, only the time the teaching physician was present can be included in determining the E/M visit level. Under the primary care exception, only medical decision-making would be used to select the visit level.

Modifier GC to be used when the teaching physician rendered the service to indicate as " The services performed in part by a resident under the direction of a teaching physician.

The CMS permits certain services added to the Medicare telehealth list to remain on the list until December 31, 2023, to collect data to determine whether services should be permanently added to the telehealth list following the COVID-19 public health emergency (PHE).

Payment Modifier Details 

Payment modifiers are accounted for in the creation of the file consistent with current payment policy as implemented in claims processing. 

• For example, services billed with the assistant at surgery modifier are paid 16 percent of the PFS amount for that service; therefore, the utilization file is modified to only account for 16 percent of any service that contains the assistant at surgery modifier.

Telehealth eye exam

The CMS continues to evaluate the inclusion of telehealth services that were temporarily added during the COVID-19 public health emergency, the agency finalized certain services added to the Medicare telehealth services list through Dec. 31, 2023. 

The AOA raised concerns with the inclusion of the eye exam codes on the telehealth covered services list, yet CMS did not address these codes. However, it did note that all services on the current telehealth covered services list would remain until 2023.