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Medicare Physician Fee Schedule Final Rule: Calendar Year 2022

December 13, 2021

Here’s What’s Changing in 2022

With numerous changes on the horizon for 2022, Coronis Health can help make sure you stay informed.

Medicare Part B Premium & Deductible Rate Increase

  • The standard premium for Medicare Part B will be $170.10 next year, up $21.60 (14.5% increase) from $148.50 this year.
  • The annual Medicare Part B deductible for all beneficiaries will be $233, up $30 (14.8% increase) from the annual deductible of $203 in 2021.
  • The bigger-than-anticipated increase is attributed to rising prices and utilization across the healthcare system and congressional action that limited the increase in the 2021 Part B premium.
  • The deductible for Medicare Part A (hospital coverage) per benefit period (which generally starts when you are admitted to the hospital) will be $1,556 in 2022, up $72 from this year’s $1,484.

Payment Increase in Vaccine Administration

  • Effective January 1, 2022, CMS will pay $30 per dose for the administration of the influenza, pneumococcal and hepatitis B virus vaccines. Depending on locality, this is an increase of $10-$15 per vaccine administration.
  • CMS will maintain the current payment rate of $40 per does for the administration of the COVID-19 vaccines through the end of the calendar year in which the ongoing PHE ends.

Split (or Shared) E/M Visits Changes

  • The visit should be billed by the physician or practitioner who provides the substantive portion of the visit.
  • Split (or shared) visits can be reported for new as well as established patients.
  • A modifier is required on the claim to identify these services to inform policy and help ensure program integrity. The modifier has yet to be released by CMS.
  • Documentation in the medical record must identify the two individuals who performed the visit. The individual providing the substantive portion must sign and date the medical record.

Critical Care Services Updates

  • Critical care services may be paid on the same day as other E/M visits by the same practitioner or another practitioner in the same group of the same specialty if the visit was medically necessary and the services are separate and distinct.
  • Practitioners must report modifier -25 on the claim when reporting these critical care services.

Telehealth Services

  • Services added during the COVID-19 PHE list pertaining to Telehealth will remain on the list through December 31, 2023.
  • An in-person, non-telehealth visit must be furnished at least once every 12 months.
  • CMS is amending the current definition of interactive telecommunications system for telehealth services to include audio-only technology.

Electronic Prescribing of Controlled Substances

  • CMS will delay the start date for compliance actions related to electronic prescribing of controlled substances to Jan. 1, 2023, and delay the compliance start date for Part D prescriptions written for beneficiaries in long-term care facilities to Jan. 1, 2025.

Medicare Shared Saving Program

  • CMS will delay the increase in the quality performance standard Accountable Care Organizations must meet to be eligible to share in savings until program year 2024.

Billing for Physician Assistant Services

  • Medicare currently can only make payment to the employer or independent contractor of a PA. Beginning January 1, 2022, PAs may bill Medicare directly for their professional services.

Therapy Services

  • CMS will implement the use of new modifiers (CQ and CO to identify and make payment at 85 percent of the Part B payment amount for physical therapy and occupational therapy services for dates of service on and after January 1, 2022.

In-Home Administration of COVID-19 Vaccines

  • CMS will continue the additional payment of $35.50 for COVID-19 vaccine administration in the home under certain circumstances through the end of the calendar year in which the PHE ends.

COVID-19 Monoclonal Antibody Reimbursement Rate

  • CMS will continue to pay for COVID-19 monoclonal antibodies. CMS will maintain the $450 payment rate for administering a COVID-19 monoclonal antibody in a health care setting.

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