Medicare Final Rule for CY 2022: Physician Fee Schedule 

Release Date: November 2, 2021
Federal Register Publication Date: November 19, 2021
Effective Date: January 1, 2022 

Physician Fee Schedule Proposed Rule: 

*PFS conversion factor reflects the statutory update of 0.00 percent and the adjustment necessary for changes in relative value units and expenditures. 

The Medicare Physician Fee Schedule (PFS) is for physicians and others billing professional services. Physician services paid under PFS are provided in various settings.  Some takeaways from the final rule include:

• Refined current policies for split (or shared) E/M visits, critical care services, and services furnished by teaching physician involving residents. 
• Refined the policies for critical care services. Critical care services that are medically necessary can be furnished as split (shared) visits and concurrently to the same patient on the same day by more than one practitioner from more than one specialty. 
• Clarified the time when a teaching physician can be included when determining the E/M visit level. 
• Allowed certain services added to the Medicare telehealth list and expanded telehealth services. 
  • Requires providers to conduct in-person, non-telehealth service within six months prior to providing an initial mental health service, and at least once every six months thereafter.
  • Allows the use of audio-only telehealth services for the diagnosis, evaluation, or treatment of mental health disorders furnished by practitioners to established patients in their homes, but only if the beneficiary is unable to have access to two-way, audio/video technology. 
• Revised standards established for services provided by Physical Therapy Assistants (PTA) and Occupational Therapy Assistants (OTA) to allow a 15-minute timed service to be billed without the CQ/CO modifier in cases when PTA/OTA participates in providing care to the patient. 
• Physician Assistants may bill Medicare directly and receive payments for professional services furnished under Part B. 
• CMS to pay $30 per dose for administration of influenza, pneumococcal, and hepatitis B vaccines. COVID-19 vaccine administration payment rate for administration will be the same as other Part B preventive vaccines. 
• Provisions finalized to enhance the abilities of RHCs and FQHCs to furnish care to underserved Medicare beneficiaries. 
  • Allow RHCs and FQHCs to report and receive payment for mental health visits furnished via real-time telecommunication technology in the same way as in-person visits. An in-person visit must be furnished at least every 12 months for these services. 
  • FQHC and RHCs eligible to receive payment for hospice attending physician services when provided by FQHC/RHC physician, nurse practitioner, or physician assistant who is employed or under contract with the FQHC/RHC. 
• CMS finalized changes to the Medicare Shared Savings Program (MSSP) including the quality measure under the Alternative Payment Model (APM) Performance Pathway (APP) for Accountable Care Organizations. 
• Provider enrollment regulatory revisions have been finalized to strengthen program integrity. 
• CMS finalized changes to the Medicare Ground Ambulance Data Collection System. There is new data collection period between January 1, 2023 and December 31, 2023. Selected ground ambulance have a new reporting period between January 1, 2024 and December 31, 2024 period in year three. 

Sources: CMS CY 2022 Medicare Physician Fee Schedule Final Rule