Advocacy Alert: CMS Releases 2022 Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment System Final Rules

On Tuesday, Nov. 2, the Centers for Medicare & Medicaid Services (CMS) released the 2022 Medicare Physician Fee Schedule (MPFS) and the Hospital Outpatient Prospective Payment System (HOPPS) final rules. Following ASNC's preliminary analysis of both rules, we want to make you aware of key policies and their potential implications.

CONVERSION FACTOR: According to the MPFS, the 2022 Medicare conversion factor will be reduced by approximately 3.71 percent – from 34.8931 in 2021 to 33.5983 in 2022. This reduction is largely a result of the expiration of a 3.75 percent increase provided by Congress to physician fee schedule amounts.

ADVOCACY UPDATE: ASNC is continuing to urge Congress to extend the 3.75 percent increase for 2022, as the cut exacerbates the financial instability that physician practices around the country are still experiencing as a result of the COVID-19 public health emergency. 

CLINICAL LABOR PRICING UPDATES: CMS finalized clinical labor pricing updates and is phasing in the pricing over four years. ASNC supported a phased-in approach as this policy should help in easing cuts observed in the CY2022 proposed rule. Stay tuned to ASNC Flashpoint for exact CY2022 payment rates.

Medicare Appropriate Use Criteria Program 

In the Medicare Physician Fee Schedule, CMS finalized the proposal to implement the penalty phase of the Appropriate Use Criteria (AUC) Mandate beginning on January 1, 2023, or the first January 1 following the declared end of the COVID-19 public health emergency.

In the rule, CMS acknowledged comments from stakeholders such as ASNC who believe the AUC Program should be further delayed or abandoned. The final rule reiterated that the program is required by statute and thus CMS must implement the program within the bounds of its statutory authority. CMS also noted the “challenging nature” of the AUC Program, referencing an issue raised by ASNC and others – the furnishing professional will be subject to immediate penalty based on the actions (or lack thereof) of the ordering professional, whose behavior the furnishing professional is unable to control.

ADVOCACY UPDATE: Earlier this year, ASNC led an effort resulting in language in the FY2022 Health and Human Services spending bill passed by the U.S. House of Representatives that calls on CMS to prepare a report to Congress on AUC Program implementation and, in doing so, to consider existing quality improvement programs and their influence on encouraging appropriate use of advanced diagnostic imaging. While CMS acknowledged the congressional language in the final rule, the agency did not comment further on its intentions to fulfill the request, which will not become final until Congress completes action on the spending bill.

National Coverage Determination for PET Scans 

The MPFS also finalized the proposal to remove the national coverage determination (NCD) for PET scans for non-oncologic indications under NCD 220.6.

NCD 220.6 has required broad national non-coverage for non-oncologic indications for PET services since 2000. The removal of NCD 220.6 does not affect NCDs 220.6.1 through 220.6.20 and will not affect NCDs 220.6.1 PET for perfusion of the heart and 220.6.8 FDG PET for viability. ASNC supported the recommendation to remove 220.6 given that existing coverage for PET perfusion of the heart and FDG PET for viability are not affected by the removal. 

More Analysis Coming from ASNC

ASNC will release further analysis of the final rules in the days ahead. Watch ASNC Flashpoint for additional insights. For the full text of the final rules and the CMS fact sheets, use these links:  
ASNC's advocacy team
is continuing to work for you and will keep you informed.