Update on New Policies in 2022 Medicare Physician Fee Schedule (MPFS) Final Rule
The Centers for Medicare & Medicaid Services (CMS) released the final FY 2022 Medicare Physician Fee Schedule (MPFS) Rule and Fact Sheet on November 2, 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 policy:
- Defines reimbursement cuts for therapy services
- Reduces the OTA modifier payment reduction
- Defines KX thresholds
- Corrects a practice expense issue with the OT evaluation codes
- Extends the telehealth Category 3 codes until the end of 2023
- Will consider comments on the continuation of direct supervision via audio-visual communication
- Allows therapists to use new remote therapeutic monitoring codes
- Updates MIPS
Cuts to Therapy Services
In the final rule, CMS slightly mitigated the cuts set to return in 2022 stemming from the 2021 Evaluation and Management code changes by transitioning the clinical labor pricing policy over 4 years. 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 2022.
OTA Modifier
CMS is finalizing its policy that a 15% reduction will apply to all services billed with a CO modifier indicating that the service was performed “all or in part” by an occupational therapy assistant, effective January 1, 2022. CMS finalized AOTA’s recommendations for application of the modifier to be consistent with the Medicare 8-minute rule. As a result, the payment differential policy will now 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. AOTA continues to advocate with Congress to minimize the effects of this payment policy. You can also take action now and ask Congress to support the SMART Act which would implement three policies to help protect and promote OTA services.
CMS also clarified that the 15% reduction will be applied to the Medicare payment only, not the coinsurance amount.
KX Threshold
The threshold amount for the KX modifier for 2022 will be $2,150 for occupational therapy services. The medical review threshold will remain at $3,000.
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 finalized a solution to this technical error, and the correction will result in an increase in reimbursement of approximately $2 per evaluation code beginning in 2022.
Telehealth Codes
Therapy services can continue to be provided via telehealth during the public health emergency (PHE). CMS finalized the extension of the Category 3 telehealth code list, which includes therapy codes, until December 31, 2023. However, without legislation, occupational therapy practitioners will not be able to bill for telehealth services after the PHE ends. This extension will allow additional time for AOTA legislative and regulatory advocacy to make the telehealth therapy code permanent.
Direct Supervision Via Audio-Visual Communication
CMS sought comment on whether direct supervision by audio-visual communication should become a permanent policy. While CMS continues to consider the issue, the final rule states that the change in direct supervision requirements that was implemented for the PHE will stop at the end of the year in which the PHE ends.
Remote Therapeutic Monitoring
In the final rule CMS reversed their previously unfavorable decision on the five new remote therapeutic monitoring CPT® codes for payment. CMS will permit therapists to bill for the new services beginning in 2022. The codes are considered “sometimes therapy,” and the OTA payment differential will apply. Additional billing guidance on the new remote therapeutic monitoring codes will be forthcoming on the AOTA website.
Quality Payment Program Merit-Based Incentive Payment System (MIPS)
The MIPS Value Pathways (MVPs) program will begin in 2023. CMS 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.
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 will continue to reweight the promoting interoperability category for performance year 2022.
Quality Measure 154, Falls Prevention, has been deleted from the MIPS program beginning in 2022.
Next Steps
AOTA will continue to analyze the final rule and share relevant policy changes. Additional educational materials on the OTA modifier and remote therapeutic monitoring codes are forthcoming. Stay tuned to the AOTA website and social media channels for more information on our ongoing advocacy efforts with Congress to reduce the payment cuts and protect OTA services.