CMS Releases CY 2022 Medicare Part B Proposed Payment Rule
The Centers for Medicare & Medicaid Services (CMS) released the proposed FY 2022 Medicare Physician Fee Schedule (MPFS) Rule and Fact Sheet on July 13, 2021. Below is an outline of some of the key changes that have implications for occupational therapy practitioners in FY 2022, followed by more information on each.
CMS proposes to:
- Impose additional cuts to reimbursement for therapy services
- Finalize the OTA modifier payment reduction
- Correct a practice expense issue with the OT evaluation codes
- Extend the telehealth Category 3 codes until the end of 2023
- Seek comment on the continuation of direct supervision via audio-visual communication
- Propose therapists cannot use new remote therapeutic monitoring codes
Cuts to Therapy Services
In the proposed rule, CMS did not mitigate the cuts set to return in 2022 stemming from the 2021 Evaluation and Management code changes. With the additional 3.75% funding Congress provided for 2021 coming to an end, the conversion factor for the 2022 fee schedule is dropping to $33.59 from $34.89 in 2021. These cuts will be in addition to the 3% cut already taken from 2020 fee schedule rates and will vary for practitioners, based on code usage and differences in locality. AOTA, along with a large coalition of health care providers, will continue to advocate with Congress and CMS to provide solutions to stop Medicare cuts.
OTA Modifier
CMS is finalizing its policy that a 15% reduction will apply to all services billed with a CO modifier indicating the service was performed all or in part by an occupational therapy assistant, effective January 1, 2022. As a result of a series of AOTA-initiated meetings with CMS officials earlier this year, CMS also provides additional guidance on the application of the modifier. AOTA, along with APTA, advocated with CMS to urge agency officials to correctly incorporate the 8-minute rule into the de minimus standard calculation. CMS agreed with our recommendations, and the rule now does not apply when the therapist performs at least 8 minutes of the last unit of service.
Additional guidance on applying the modifiers will be forthcoming from AOTA Regulatory staff on the AOTA website and as part of the Summer Series webinars in September. AOTA continues to advocate with Congress and CMS to minimize the effects of this payment policy.
OT Evaluations Practice Expense
As a result of AOTA advocacy, CMS addresses an error in the computation of indirect practice expense for the OT evaluation codes that resulted in lower relative value units (RVUs) in 2021. CMS has proposed a solution, and the correction will result in an increase in reimbursement to the evaluation codes in 2022.
Telehealth Codes
Based on the advocacy of AOTA and partner therapy stakeholders, CMS is proposing to extend the Category 3 telehealth code list, which includes therapy codes, until December 31, 2023. The list is currently set to terminate at the end of 2021, so this will allow additional time for legislative and regulatory advocacy to get the therapy code set made permanent telehealth codes.
Direct Supervision Via Audio-Visual Communication
CMS is seeking comment on whether or not direct supervision by audio-visual communication should become a permanent policy. Currently, the change in direct supervision requirements that was implemented for the public health emergency (PHE) is scheduled to end at the end of the year.
Remote Therapeutic Monitoring
CMS reviewed five new remote therapeutic monitoring CPT® codes for payment. Even though these codes are meant to be billed by nonphysician health care professionals, CMS decided that based on the similarities to remote physiologic monitoring codes, the services cannot be billed by therapists as constructed. CMS is seeking comment on how to remedy the issues with code construction so that nonphysician practitioners may bill the codes.
Quality Payment Program Merit-Based Incentive Payment System (MIPS)
CMS has proposed that the MIPS Value Pathways (MVPs) program will begin in 2023. They introduced seven MVP options for the first year that include rheumatology, stroke care and prevention, heart disease, chronic disease management, emergency medicine, lower extremity joint repair, and anesthesia. CMS is proposing to sunset traditional MIPS reporting and require reporting of only MVPs starting in 2028.
Category weighting for traditional MIPS will change with an increase in the cost category to 30% and a decrease in the quality category to 30%. Five new cost measures have been added, but none are attributable to occupational therapy, so the cost category will once again be reweighted. Additionally, CMS is proposing to continue to reweight the promoting interoperability category for performance year 2022.
AOTA will continue to analyze the proposed rule and share relevant policy changes. AOTA is developing a comment letter regarding CMS’ proposed policies and encourages you to comment as well. Stay tuned for more information on our ongoing advocacy efforts with CMS and Congress.