CMS releases annual payment updates

On November 2, the Centers for Medicare and Medicaid Services (CMS) released its annual payment updates for physicians and outpatient and home health services for 2022.

A statement from CMS said, these are “actions that will advance its strategic commitment to drive innovation to support health equity and high quality, person-centered care. CMS’ Calendar Year (CY) 2022 Physician Fee Schedule (PFS) final rule will promote greater use of telehealth and other telecommunications technologies for providing behavioral health care services, encourage growth in the diabetes prevention program, and boost payment rates for vaccine administration. The final rule also advances programs to improve the quality of care for people with Medicare by incentivizing clinicians to deliver improved outcomes.”

“Promoting health equity, ensuring more people have access to comprehensive care, and providing innovative solutions to address our health system challenges are at the core of what we do at CMS,” said CMS Administrator Chiquita Brooks-LaSure. “The Physician Fee Schedule final rule advances all these strategic priorities and helps build a better Medicare program for the future.”

Among the highlights:

  1. The conversion factor used to determine provider reimbursement will drop to $33.59 in 2022 from $34.89 this year as a temporary payment boost provided by the Consolidated Appropriations Act expires.
  2. CMS is amending the definition of interactive telecommunications system for telehealth services to include audio-only communications technology used to diagnose, evaluate or treat mental health disorders in certain cases. The agency also clarified that mental health services can include treatment of substance use disorders.
  3. The final rule will nearly double Medicare Part B payment rates for certain vaccines, including influenza, pneumonia and hepatitis B. CMS said it hopes the increase in payment rates — from $17 to $30 — will improve access and lead to greater vaccination uptake.
  4. CMS is updating the clinical labor rates that are used to calculate practice expenses under the Physician Fee Schedule for the first time in nearly two decades. As a result, payments to primary care specialists that involve more clinical labor, such as geriatrics and family practice, are expected to increase.

Read the 2,414-page rule here.